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Background Histoplasmosis is acquired by inhalation of spores of the dimorphic fungus Histoplasma spp. Although this pathogen is distributed worldwide, it is more prevalent in the Americas. However, the real burden of histoplasmosis remains undefined in many endemic regions. Methodology We conducted a series of 61 autopsies to individuals who died in a hospital in the Brazilian Amazon focused on infectious diseases. We performed a detailed histological and microbiological evaluation with genetic characterization of Histoplasma strains with the aim to evaluate the contribution of histoplasmosis to morbidity and mortality. Additionally, we assessed the clinicopathological correlation. Principal findings Evidence of Histoplasma infection was detected in 21 patients (34%). Eight cases were disseminated infections, all of them occurred in HIV-positive patients. Six cases were localized histoplasmosis, limited to the lungs. In seven patients Histoplasma DNA was detected by PCR in patients with no histological lesions. Histoplasma infection was detected in 38% of HIV-positive patients and was a major contributor to death in 22% of them. Lungs, liver and spleen were affected in all cases of disseminated histoplasmosis. Phylogenetic analysis of the strains suggested a high diversity of Histoplasma species circulating in the Brazilian Amazon. Histoplasmosis was clinically missed in 75% of the disseminated infections. Conclusions The high incidence of histoplasmosis, the low index of clinical suspicion, and the severity of the disseminated disease highlight the need of proactively implementing sensitive routine screening methods for this pathogen in endemic areas. Antifungal prophylaxis against Histoplasma should be encouraged in the severely immunocompromised HIV patients in these areas. In conclusion, substantial mortality is associated with disseminated histoplasmosis among HIV-positive patients in the Brazilian Amazon., Author summary Histoplasmosis is a fungal infection caused by inhalation of spores of the fungus Histoplasma spp. It occurs in specific endemic areas, such as areas of USA, Africa and Latin America. However, the real burden of histoplasmosis remains unknown in many endemic regions. Clinically, histoplasmosis is frequently misdiagnosed as tuberculosis. The current study was carried out to explore the frequency and characteristics of Histoplasma infection in a series of autopsies conducted in the Brazilian Amazon. We found evidence of Histoplasma infection in one-third of the deceased patients. A significant proportion of the cases were disseminated infections, with extensive involvement and severe damage of most organs. All these disseminated infections occurred in HIV-positive patients. Strikingly, histoplasmosis was clinically missed in more than two-thirds of these patients and had an extremely high mortality. In conclusion, the high frequency and mortality of histoplasmosis, together with the frequent misdiagnosis of the disease, highlight the need of implementation of sensitive screening methods for Histoplasma in HIV patients in endemic areas. Additionally, antifungal prophylaxis against Histoplasma should be encouraged in the severely immunocompromised HIV patients in these areas.

CD5 is a scavenger receptor mainly expressed on lymphoid (T and B1a) cells but also on some minor myeloid (Mϕ and DCs) cell subsets. It is long known to negatively modulate differentiation and activation signals mediated by the clonotypic antigen specific receptor complexes of T (TCR) and B1a (BCR) lymphocytes, both being an identity hallmark of the adaptive immune system (Burgueño‐Bucio et al., 2019). Recently, several reports have also shown its ability to recognise and signal the presence of PAMPs of fungal, viral and parasitic origin (Consuegra-Fernández et al., 2015; Burgueño‐Bucio et al., 2019), which is a formal trait of PRRs expressed by the innate immune system’s components (Salazar and Brown, 2018). In consequence, CD5 can be considered as a relevant immunomodulatory receptor at the interphase between the innate and adaptive immune responses. IFIs have emerged in recent decades as a significant health problem associated with high morbidity, mortality, and economic burden (Klingspor et al., 2015). Nowadays, only a few antifungal drugs are available and their use is limited by their associated side effects, making necessary the development of new alternative or complementary therapeutic strategies (Nami et al., 2019). The discovery by our group that CD5 binds with relative high affinity to and signal the presence of β-glucans (Vera et al., 2009) -a constitutive and highly conserved component of fungal cell walls -motivated our interest on exploring the CD5’s physiological function and/or therapeutic potential in IFIs. In our view, the study of soluble and/or membrane-bound immune receptors involved in antifungal immunity, as it may be the case of CD5, could provide an important source of functional information to be translated into such a novel therapeutic approaches. Based on the above mentioned premises, the specific objectives of this thesis have been the following: - To study the influence of the mouse genetic background on fungal infection by analyzing the antifungal immune response of the inbred (C57) and outbred (CD1) mouse strains most widely used in basic and pharma-industry research. - To study the influence of membrane-bound CD5 on fungal infection by analyzing the antifungal immune response of mice genetically deficient for CD5 (cd5-/-). - To study the therapeutic potential of soluble human CD5 administration (alone or in combination) in experimental models of fungal infection. - To study the therapeutic potential of CD5-based adoptive cell transfer strategies by analysing the influence of immune cells transduced with membrane-bound chimerical CD5 receptors in pre-clinical models of fungal infection.

Lymphomatoid contact dermatitis is an uncommon inflammatory disorder of the skin that is classified as a pseudolymphoma. It is probably an under‐reported entity, combining the clinical and histological features of cutaneous T cell lymphoma (CTCL) with some characteristics of allergic contact dermatitis. Aetiologically, it has been linked to several haptens, such as phosphorus sesquisulfide 1, 2, gold, nickel, dimethyl fumarate, methylisothiazolinone, and azo dyes. Delayed‐type hypersensitivity is regarded as the key in pathogenesis; avoidance of the hapten usually leads to resolution, and clonality cannot be proven in most cases. We report on the first case of lymphomatoid contact dermatitis in relation to limonene hydroperoxides (LimOOHs).

[spa] La piel constituye una de las primeras líneas de defensa de nuestro organismo y, como tal, puede sufrir la agresión de numerosos microorganismos y parásitos. Entre estas patologías cabe mencionar las micosis y la leishmaniosis que pueden tratarse con una variedad de fármacos presentados bajo diferentes formas farmacéuticas diseñadas para las vías de administración correspondientes, siendo las vías más habituales la cutánea, oral y parenteral. Para el tratamiento de afecciones de la piel y sus anejos, la vía cutánea en principio es la de elección, sin embargo, en algunos casos no aporta los resultados terapéuticos esperados, frecuentemente debido a una escasa penetración y/o retención del fármaco a nivel dérmico. Esta falta de eficacia podría paliarse con el uso de vehículos tales como nanoemulsiones e hidrogeles termorreversibles, dando lugar a nuevas formulaciones que podrían usarse como alternativa a los medicamentos de administración oral o parenteral para el tratamiento de patologías cutáneas. La Anfotericina B podría ser un buen candidato, dado su potencial nefrotóxico por vía oral y la ausencia en Europa de medicamentos con este principio activo para su administración cutánea. Si estas nuevas formulaciones fueran viables, supondrían una buena alternativa, dado que en principio se reducirían considerablemente los posibles efectos indeseables del fármaco. Además, comparado con los inyectables, presentarían el beneficio de una administración no invasiva e indolora. Para el desarrollo de la Tesis se ha realizado un amplio estudio bibliográfico preliminar que viene sintetizado en el capítulo 1 de la memoria. Seguidamente, en el capítulo 2, se exponen los objetivos y plan de trabajo establecido. Los demás capítulos tratan de la parte experimental con sus conclusiones finales., [eng] The skin constitutes one of the first lines of defense of our organism and, as such, it can suffer the aggression of many microorganisms and parasites. These pathologies include the mycosis and leishmaniosis that can be treated with a variety of drugs presented under different pharmaceutical forms designed for the corresponding routes of administration, the most common oral, cutaneous and parenteral pathways. For the treatment of skin conditions and their annexes, the skin route in principle is the one of choice, however, in some cases it does not provide the expected therapeutic results, often due to poor penetration and / or retention of the drug at the dermal level. This lack of efficiency could be mitigated by the use of vehicles such as nanoemulsions and thermorreversible hydrogels, giving rise to new formulations that could be used as an alternative to oral or parenteral administration medications for the treatment of cutaneous pathologies. Amphotericin B may be a good candidate, given its oral nephrotoxic potential and the absence in Europe of medications with this active ingredient for its skin administration. If these new formulations were viable, they would be a good alternative, since in principle the potential undesirable effects of the drug would be considerably reduced. In addition, compared with injectables, they would present the benefit of non-invasive and painless administration. For the development of the Thesis, a comprehensive preliminary bibliography study has been carried out which is summarized in Chapter 1 of the report. Next, in Chapter 2, the objectives and established work plan are set out. The other chapters deal with the experimental part with its final conclusions.

Voce biografica sul medico Alfonso Splendore (1871-1953)

Purpose Advanced-stage mycosis fungoides (MF; stage IIB to IV) and Sézary syndrome (SS) are aggressive lymphomas with a median survival of 1 to 5 years. Clinical management is stage based; however, there is wide range of outcome within stages. Published prognostic studies in MF/SS have been single-center trials. Because of the rarity of MF/SS, only a large collaboration would power a study to identify independent prognostic markers. Patients and Methods Literature review identified the following 10 candidate markers: stage, age, sex, cutaneous histologic features of folliculotropism, CD30 positivity, proliferation index, large-cell transformation, WBC/lymphocyte count, serum lactate dehydrogenase, and identical T-cell clone in blood and skin. Data were collected at specialist centers on patients diagnosed with advanced-stage MF/SS from 2007. Each parameter recorded at diagnosis was tested against overall survival (OS). Results Staging data on 1,275 patients with advanced MF/SS from 29 international sites were included for survival analysis. The median OS was 63 months, with 2- and 5-year survival rates of 77% and 52%, respectively. The median OS for patients with stage IIB disease was 68 months, but patients diagnosed with stage III disease had slightly improved survival compared with patients with stage IIB, although patients diagnosed with stage IV disease had significantly worse survival (48 months for stage IVA and 33 months for stage IVB). Of the 10 variables tested, four (stage IV, age > 60 years, large-cell transformation, and increased lactate dehydrogenase) were independent prognostic markers for a worse survival. Combining these four factors in a prognostic index model identified the following three risk groups across stages with significantly different 5-year survival rates: low risk (68%), intermediate risk (44%), and high risk (28%). Conclusion To our knowledge, this study includes the largest cohort of patients with advanced-stage MF/SS and identifies markers with independent prognostic value, which, used together in a prognostic index, may be useful to stratify advanced-stage patients.

Mucorales are an emerging group of human pathogens that are responsible for the lethal disease mucormycosis. Unfortunately, functional studies on the genetic factors behind the virulence of these organisms are hampered by their limited genetic tractability, since they are reluctant to classical genetic tools like transposable elements or gene mapping. Here, we describe an RNAi-based functional genomic platform that allows the identification of new virulence factors through a forward genetic approach firstly described in Mucorales. This platform contains a whole-genome collection of Mucor circinelloides silenced transformants that presented a broad assortment of phenotypes related to the main physiological processes in fungi, including virulence, hyphae morphology, mycelial and yeast growth, carotenogenesis and asexual sporulation. Selection of transformants with reduced virulence allowed the identification of mcplD, which encodes a Phospholipase D, and mcmyo5, encoding a probably essential cargo transporter of the Myosin V family, as required for a fully virulent phenotype of M. circinelloides. Knock-out mutants for those genes showed reduced virulence in both Galleria mellonella and Mus musculus models, probably due to a delayed germination and polarized growth within macrophages. This study provides a robust approach to study virulence in Mucorales and as a proof of concept identified new virulence determinants in M. circinelloides that could represent promising targets for future antifungal therapies., Author Summary Mucormycosis is an infectious disease caused by organisms of the order Mucorales. It is a lethal infection that is raising the alarm in the medical and scientific community due to its high mortality rates, unusual antifungal drug resistance and its emerging character. Among the reasons explaining the nescience about this disease is the lack of knowledge on the biology of the organisms that cause mucormycosis, which is encouraged by the reluctance of these species to genetic studies. In this work, we have developed an RNAi-based functional genomic platform to study virulence in Mucorales. It is a powerful tool available for the scientific community that will contribute to solve the reluctance of Mucorales to genetic studies and will help to understand the genetic basis of virulence in these organisms. Secondly, and as a proof of concept, we have used this genetic tool to identify two new virulence determinants in Mucor circinelloides. Lack of function of these determinants delays germination and growth of spores, conceding time to macrophages for the inactivation of the pathogen. The two genes identified, mcplD and mcmyo5, represent promising targets for future development of new antifungal therapies against mucormycosis.

Mucorales are an emerging group of human pathogens that are responsible for the lethal disease mucormycosis. Unfortunately, functional studies on the genetic factors behind the virulence of these organisms are hampered by their limited genetic tractability, since they are reluctant to classical genetic tools like transposable elements or gene mapping. Here, we describe an RNAi-based functional genomic platform that allows the identification of new virulence factors through a forward genetic approach firstly described in Mucorales. This platform contains a whole-genome collection of Mucor circinelloides silenced transformants that presented a broad assortment of phenotypes related to the main physiological processes in fungi, including virulence, hyphae morphology, mycelial and yeast growth, carotenogenesis and asexual sporulation. Selection of transformants with reduced virulence allowed the identification of mcplD, which encodes a Phospholipase D, and mcmyo5, encoding a probably essential cargo transporter of the Myosin V family, as required for a fully virulent phenotype of M. circinelloides. Knock-out mutants for those genes showed reduced virulence in both Galleria mellonella and Mus musculus models, probably due to a delayed germination and polarized growth within macrophages. This study provides a robust approach to study virulence in Mucorales and as a proof of concept identified new virulence determinants in M. circinelloides that could represent promising targets for future antifungal therapies.

[spa] En la presente tesis doctoral se estudia la problemática actual sobre la candidemia en el caso de pacientes adultos y se analizan las estrategias de manejo. En concreto, se aborda el estudio de utilidad de un “score” clínico en la selección empírica de tratamientos antifúngicos en pacientes con candidemia, la problemática actual de las candidemias de brecha, el impacto pronóstico de la utilización de equinocandinas en las candidemias de foco urinario y finalmente el probable rol inmunomodulador de las estatinas en el pronóstico de los pacientes con candidemia.

DOI: 10.1016/j.ijantimicag.2015.12.020 In this study, 27 clinical isolates of Candida glabrata with voriconazole (VRC) minimum inhibitory concentrations (MICs) ranging from ¿0.03 ¿g/mL to 8 ¿g/mL were tested to determine whether in vitro data are predictive of in vivo efficacy. The efficacy of VRC administered at 40 mg/kg was assayed in a neutropenic murine model of disseminated infection by C. glabrata. The reduction in fungal tissue burden in the kidneys was used as a marker of treatment efficacy. VRC reduced the fungal tissue burden in mice infected with strains that had MICs below the epidemiological cut-off value (ECV) of 0.25 ¿g/mL. Variable efficacy of VRC was obtained when the MIC equalled the ECV, and VRC was ineffective when the MIC exceeded the ECV. These results suggest that the use of in vitro data could be useful to predict the outcome for infections by this fungus.

si offre una panoramica sulle principali malattie infettive delle lamiacee

Treball Final de Grau de Podología, Escola Universitaria d'Infermeria, Universitat de Barcelona, curs: 2014-2015, Tutor: Carmen Moliné Regla, Las infecciones dérmicas causadas por hongos afectan a millones de personas en todo el mundo, la tinea pedis es la más común de estas infecciones en nuestra sociedad llegando a afectar a un 79% de la población. Este tipo de infección se ubica específicamente en la zona del pie y representa una de las causas más frecuentes de consulta de pacientes inmunodeprimidos y de edad avanzada. A menudo su diagnóstico provoca confusión debido al gran número de signos y síntomas que presenta según el patógeno que la produce, influyendo todo ello en la elección del tratamiento más certero. El pronóstico suele ser favorable si el paciente cumple con las medidas de prevención y sigue el tratamiento adecuado establecido por el profesional sanitario.

Dopo una panoramica sul mondo dei funghi, vengono trattate le principali micosi che interessano l'alveare: ascosferosi o covata calcificata, aspergillosi o covata pietrificata e la muffa del polline (Bettsia alvei).

Treballs d'Educació Farmacètica als ciutadans. Unitat Docent d'Estades en Pràctiques Tutelades. Facultat de Farmàcia , curs: 2012-2013, Directors: Ramon Jódar Masanes, Anna Mas Comas i Marian March Pujol, Les micosis superficials són afeccions molt comunes, i més en el cas de la població pediàtrica, que no solen respondre a la simptomatologia de manera ràpida com ho pot fer un individu adult. En el nostre treball ens centrem principalment en el peu d’atleta (Tinea pedis). Els tres missatges claus que volem transmetre als nens que assitiaran a la sessió són: 1) Definir el concepte de fong, i deixar palès la diferència entre aquells que són comestibles i els que són patògens. 2) Remarcar la necessitat d’una actuació precoç davant la sospita d’una micosi i el consell farmacèutic, ja que l’autotractament pot empitjorar el pronòstic de la malaltia. 3) Donar uns consells bàsics per a la prevenció de les micosis cutànies en l’ambient escolar i/o extraescolar.

La criptococcosi è la più frequente micosi sistemica del gatto ed è sostenuta da lieviti capsulati del genere Cryptococcus. L’infezione, che solitamente si verifica attraverso inalazione di basidiospore, interessa principalmente le cavità nasali e può estendersi a sistema nervoso, occhio, linfonodi, cute e meno frequentemente ad altri organi. Viene descritto un inusuale caso di criptococcosi a localizzazione splenica in un gatto europeo maschio castrato di 3 anni. Il soggetto era presentato per disoressia ed episodi di costipazione; la visita clinica e gli esami ematobiochimici evidenziavano esclusivamente dimagrimento e una modica ipertermia (40°C). In seguito al riscontro ecografico di splenopatia diffusa di grado lieve veniva eseguito un prelievo citologico ecoguidato. Nei preparati, colorati con May-Grünwald Giemsa e successivamente con mucicarminio di Mayer, si osservavano numerosi microrganismi lievitiformi circondati da una spessa capsula, con aspetti di gemmazione a base stretta, talora fagocitati da cellule epiteliodi e cellule giganti multinucleate. La diagnosi citologica di splenite granulomatosa a eziologia micotica era successivamente confermata dall’esame istologico condotto su campioni di milza asportata. Nelle sezioni istologiche erano presenti ampi focolai di infiammazione granulomatosa frammisti ad aree di tessuto “rarefatto” per la presenza di numerosi lieviti circondati da un’ampia capsula mucoide otticamente vuota che conferivano il caratteristico aspetto “a bolla di sapone”. I microrganismi erano positivi alle colorazioni istochimiche PAS e Grocott e nei preparati colorati con mucicarminio di Mayer la capsula risultava intensamente colorata in rosa-rosso. L'esame colturale eseguito su Sabouraud dextrose agar addizionato di cloramfenicolo, ha permesso la crescita in purezza a 26°C e 37°C di colonie di lieviti le cui caratteristiche morfologiche, colturali e biochimiche erano indicative per Cryptococcus neoformans. Nonostante la terapia con itraconazolo, a distanza di due mesi il soggetto sviluppava distacco retinico. La terapia a base di cortisone, diuretici e fluconazolo determinava la completa remissione della sintomatologia oculare. A distanza di 18 mesi dalla diagnosi il soggetto, ancora sotto terapia antifungina per la persistenza di un elevato titolo antigenico, non presenta fenomeni di recrudescenza.

Mycosis fungoide (MF) patients who develop tumors or extracutaneous involvement usually have a poor prognosis with no curative therapy available so far. In the present European Organization for Research and Treatment of Cancer (EORTC) multicenter study, the genomic profile of 41 skin biopsies from tumor stage MF (MFt) was analyzed using a high-resolution oligo-array comparative genomic hybridization platform. Seventy-six percent of cases showed genomic aberrations. The most common imbalances were gains of 7q33.3q35 followed by 17q21.1, 8q24.21, 9q34qter, and 10p14 and losses of 9p21.3 followed by 9q31.2, 17p13.1, 13q14.11, 6q21.3, 10p11.22, 16q23.2, and 16q24.3. Three specific chromosomal regions, 9p21.3, 8q24.21, and 10q26qter, were defined as prognostic markers showing a significant correlation with overall survival (OS) (P = 0.042, 0.017, and 0.022, respectively). Moreover, we have established two MFt genomic subgroups distinguishing a stable group (0-5 DNA aberrations) and an unstable group (> 5 DNA aberrations), showing that the genomic unstable group had a shorter OS (P = 0.05). We therefore conclude that specific chromosomal abnormalities, such as gains of 8q24.21 (MYC) and losses of 9p21.3 (CDKN2A, CDKN2B, and MTAP) and 10q26qter (MGMT and EBF3) may have an important role in prognosis. In addition, we describe the MFt genomic instability profile, which, to our knowledge, has not been reported earlier.

Obiettivi. Effettuare una revisione sistematica sui farmaci disponibili per il trattamento della candidosi orale in modo da scegliere la terapia più adeguata. Materiali e metodi. La candidosi orale rappresenta una causa sempre più frequente di infezione che può in taluni casi compromettere la qualità della vita del paziente. L’alta incidenza della candidosi orale può essere correlata con una molteplicità di fattori predisponenti che favoriscono la conversione della Candida da commensale a parassita. Alcuni fattori che contribuiscono a questo incremento sono rappresentati dai trattamenti antibiotici ad ampio spettro, dalla terapia con glucocorticoidi, dall’aumento dei pazienti severamente immunocompromessi, fra I quali soggetti affetti da AIDS, pazienti con neutropenia conseguente alla chemioterapia antineoplastica ecc. Risultati. Il trattamento della candidosi orale richiede l’identificazione dei fattori predisponenti, locali e sistemici, l’eliminazione degli stessi, un’accurata igiene orale e la somministrazione di farmaci antimicotici locali o sistemici. Discussione e conclusioni. Dalla letteratura si evince che un antimicotico ideale per il trattamento della candidosi orale non è ancora disponibile. OBJECTIVES. To carry out a systematic review of available drugs for the treatment of oral candidiasis in order to select the most appropriate treatment. MATERIALS AND METHODS. Oral candidiasis is a more and more frequent infection that in some cases can compromise patient's quality of life. The increasing frequency of oral candidiasis can be correlated to a number of predisposing factors favouring the conversion of Candida from a commensal to a parasite condition. These factors include treatment by broadspectrum antibiotics and glucocorticoids, the increasing of immuno-compromised patients, including subjects affected by AIDS, and neutropenia following chemotherapy. RESULTS. The treatment of oral candidiasis requires to identify both local and systemic predisposing factors, to eliminate them, to have good oral hygiene and to administer local or systemic antimycotic drugs. DISCUSSION AND CONCLUSIONS. The available literature shows that an ideal drug for the treatment of oral candidiasis is not yet available.

Nell’ultimo decennio anche in campo veterinario si è assistito ad un sempre maggiore interesse nei confronti della medicina naturale. Nella cura degli animali d’affezione è spesso il proprietario che tende a preferire questo tipo di approccio terapeutico considerato anche il battage pubblicitario e la commercializzazione di estratti vegetali rivolti proprio alla medicina veterinaria. Nel campo della terapia antifungina, in Italia in ambito veterinario sono stati effettuati vari studi in vitro sull’efficacia di diversi oli essenziali nei confronti di dermatofiti, Saprolegniaceae, Candida albicans, Malassezia spp., Aspergillus fumigatus, Ascosphaera apis. Molto spesso gli oli di Timo, Origano e Santoreggia hanno mostrato il maggiore effetto antifungino. Per quanto riguarda l’applicazione in vivo, oltre a considerare che gli animali sono utilizzati quali cavie per la sperimentazione riguardante efficacia e tollerabilità di alcuni oli essenziali, si può evidenziare come in apicoltura l’utilizzo del Timolo, commercializzato per combattere la varroosi, si è dimostrato efficace anche nei confronti di A. apis, ascomicete patogeno per questi insetti. In campo veterinario come in umana, prodotti a base di Melaleuca alternifolia sono frequentemente utilizzati, in purezza o in prodotti ad uso dermatologico, nei confronti delle micosi o parassitosi cutanee. L’idea del “prodotto naturale” non deve però fare dimenticare che questi oli possono avere effetti tossici, caustici o allergizzanti. Sono ad esempio segnalati in letteratura alcuni casi di intossicazione in gatti e cani come conseguenza di un uso improprio di olio di Tea tree con comparsa di sintomi nervosi, ipotermia e disidratazione. L’utilizzo di tali sostanze, non sempre innocue e con diversi gradi di tossicità nelle differenti specie animali, deve quindi avvenire sotto il diretto controllo del veterinario

The association of mycosis fungoides and a primary cutaneous CD30+ lymphoproliferative disorder has been reported and probably represents different clinical aspects of a unique T-cell monoclonal expansion. In this study, 12 patients (6 men and 6 women) presented with lymphomatoid papulosis and mycosis fungoides. A TCRgamma gene rearrangement study was performed by an automated high-resolution PCR fragment analysis method on skin biopsy specimens taken from the different clinical lesions in each patient. An indolent clinical course was observed in the majority of patients. T-cell clonality was identified in 7 of 12 lymphomatoid papulosis lesions (58%) and in 6 skin biopsies of plaque stage mycosis fungoides (50%). In each individual case, where T-cell clonality was detected, both mycosis fungoides and lymphomatoid papulosis specimens exhibited an identical peak pattern by automated high-resolution PCR fragment analysis, confirming a common clonal origin. Only one case showed a clonal TCRgamma rearrangement from the lymphomatoid papulosis lesion, which could not be demonstrated in the mycosis fungoides specimen. The demonstration of an identical clone seems to confirm that both disorders are different clinical manifestations of a unique T-cell monoclonal proliferation. Our results also seem to confirm that the association of mycosis fungoides with a primary cutaneous CD30+ lymphoproliferative disorder usually carries a favourable prognosis.

Mycosis fungoides is a cutaneous T-cell lymphoma, a subgroup of non-Hodgkin's lymphomas, characterized by skin infiltration and occasionally systemic involvement. The association of pregnancy and mycosis fungoides has not been described previously. A case of mycosis fungoides, stage IVb, in a pregnant woman is reported. Prior to pregnancy, the patient received adriamycin, cyclophosphamide, vincristine prednisolone (CHOP) and bleomycin and total body irradiation. Around the concepcional period she presented a cutaneous relapse palliated with photon radiotherapy. No obstetrics complications were observed during gestation. At 39 week's gestation a cesarean section was performed and a healthy 2900 g boy was delivered. Mycosis fungoides did not worsen during pregnancy and postpartum period. In conclusion mycosis fungoides did not adversely affect pregnancy outcome and gestation did not worsen the malignancy course. This case report may be valuable in managing patients with mycosis fungoides who are currently pregnant or are contemplating pregnancy.

Las infecciones fúngicas pueden originar diversos tipos de lesiones, tanto a nivel bucal como en otras localizaciones. En pacientes con alteraciones del nivel inmunitario, dichas infecciones ocasionan lesiones muy agresivas, a veces con graves consecuencias. El objetivo del presente trabajo es resumir las características básicas de las infecciones micóticas que afectan al ser humano, así como los principales tipos de agentes antifúngicos para su tratamiento. Se clasifican y describen los distintos fármacos disponibles, segiín su composición e indicaciones, destacando cuáles son sus ventajas y limitaciones más importantes, desde una perspectiva médico-bucal.

Se realiza una revisión del concepto de micosis oral, haciendo especial referencia al de la candidiasis oral. Se discute la etiopatogenia y de forma especial la importancia de los factores favorecedores. Asimismo se repasan las diferentes clasificaciones clínicas de la enfermedad, resaltando los aspectos más significativos de cada una de las presentaciones. Finalmente se plantea una actualización en los criterio terapéuticos y se da una pauta de actuación.

The Authors describe a clinical case of a 60 year old man with cervico-facial actinomycosis. The histology, the differential diagnosis and the successful penicillin therapy are also discussed.

El presente trabajo fue publicado en parte en la Revista Española de Podología puesto que sus autores lo llevaron al congreso de Valencia. A pesar de ello, y gracias a la amabilidad de todos cuantos lo firman, publi­camos a continuación el trabajo íntegramente, ya que nos parece que el tema tratado, y por cierto muy bien, merece toda nuestra atención y la mayor difusión posible.