Download - micosis cutanea (dermatofitos)
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DERMATOFITOSIS
M.R. RICHARD AMERICO CUEVAS CISNEROSRESIDENTE MEDICINA INTERNA-2do AÑO
NOVIEMBRE 2011
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PROPIEDADES GENERALES Y CLASIFICACION
• {HIFAS} → {MICELIOS} → CENOSITO =
MOHO MOHO
• Colonias filamentosas (hifas) multicelulares
LEVADURAS• Celulas unicas (mayoria gemacion:
pseudohifas)• Dimorfo: Mohos + Levaduras
Microbiologia medica. Jawetz, Melnick y Adelberg. 17 Ed. 2001
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ESPORASMohos-Levaduras
MOHOS → CONIDIOSHIFA (CONIDIOFORA) →
CONIDIO
ASEXUAL(ANAMORFICO)
SEXUAL(TELEMORFICO)
PROGENIEMITOTICA
Importancia medica
CIGOMICETOS(ESPONGIOSPORAS)CONIDIOS
Microbiologia medica. Jawetz, Melnick y Adelberg. 17 Ed. 2001
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• Todos, excepto los deuteromicetos (hongos imperfectos) tienen reproducción sexual y asexual
• CIGOMICETOS: Hifas poco septadas: rhizopus, absidia, MUCOR, pilobolus.
• ASCOMICOTINA: Hifas septadas: Ajellomyces (BLASTOMYCES, HISTOPLASMA), arthroderma, (MICROSPORUM, TRICHOPHYTON), o levadura como saccharomyces.
Microbiologia medica. Jawetz, Melnick y Adelberg. 17 Ed. 2001
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• BASIDIOMICOTINA: Hifas poseen septos complejos: h. seta, CRIPTOCOCO NEOFORMAS.
• DEUTEROMICOTINA: No tiene forma teleomorfa o reproduccion sexual.
Se caracteriza por conidios asexuales Ejm COCCIDIOIDES INMITIS, PARACOCCIDIODES BRASILENSIS, CANDIDA ALBICANS
Microbiologia medica. Jawetz, Melnick y Adelberg. 17 Ed. 2001
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CRECIMIENTO Y AISLAMIENTO
• Agar saborau: Contiene glucosa y petonas (Clasificacion en base a caracteristicas morfológicas de crecimiento sobre agar saborou)
Microbiologia medica. Jawetz, Melnick y Adelberg. 17 Ed. 2001
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• SUPERFICIALES– Pitiriasis versicolor (tiña
versicolor)– Tiña negra (tiña negra
palmar)– Piedra
• CUTANEAS– T. Pedis– T. Manuum– T. Capitis– T. Corporis– T. Inguinal (Cruris)– Onicomicosis
• SUBCUTANEAS– Sporotrix shenckii– Cromoblastomicosis
(Cromomicosis)– Feohifomicosis– Micetoma
– Candidiasis– Aspergiliosis– Histoplasmosis– Paracoccidiodomicosis– Criptococosis– Esporotricosis
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CLASIFICACION GENERAL
• MICOSIS SUPERFICIALES• MICOSIS CUTANEAS PROFUNDAS– DERMIS– SUBCUTIS
• MICOSIS SISTEMICAS
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CLASIFICACION DE MICOSIS SUPERFICIALES
• DERMATOFITOS– TRICHOPHYTON (T. rubrum, T. Mentagrophytes, T.
Tonsurans)– EPIDERMOPHYTON (E. Flocosum)– MICROSPORUM: (E. canis, M. Gypseum)
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• Trichophyton: Cualquier estructura cutanea, pelos y uñas
• Microsporum: Rara pliegues o uñas.• Epidermophyton: Fundamentalmente pies, ingles y
axilas
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• NO DERMATOFITOS–CANDIDA•Candida albicans•Otras: C. parapsilosis, pseudotropicalis
–MALASSESSIA•Pitirosporum•Malassessia
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TIÑAS O DERMATOFITOSIS
• Todas producidas por dermatofitos• No afectan mucosas• Dx: Clínica + cultivo, luz de Wood
normalmente negativa• Todos los climas• Mas frecuente: Trichophyton Rubrum
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• Transmisión–Contagiosidad del organismo: Tiña
capitis por T. tonsurans–Adquisición del medio ambiente: T.
corporis por M. gypseum
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• NO INFLAMATORIAS– T. Capitis– T. del cuerpo– T. de los pies– T. inguinal– T. ungueal
• INFLAMATORIAS–Querion de Celso– Favus–Granuloma
tricofitico de majocchi– Tiña de la barba
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TIÑA CAPITIS
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MICOSIS SUPERFICIALES
Agentes: endotrix: T. tonsurans ectotrix: M.canis, M audouini. T. mentagrophytes Favus : T. schoenleinii
Tratamiento: siempre oral. Griseofulvina o Terbinafine Mínimo 8 a 10 semanas
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Dos formas clinicas: Tricofitica y microsporica, caracteristicas comunes
• Escolar, muy contagiosas, epidemias• Curación espontanea al llegar a la pubertad (acidos
grasos saturados del sebo: fugiestatico y fungicida. Malassezzia sp.)
• Lesiona pelo, no afecta folículo. Alopecia reversible• Clínica: Una o varias placas total o parcialmente
alopécicas, con pelos rotos el emerger de la piel o muy poco por encima, y con descamación y prurito
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TIÑA DEL CUERPO Y LA CARA
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Tiña facial o tiña corporis
• Clínica: .Lesión anular (a veces de gran tamaño)
• Muchos pacientes describen el inicio como picadura o impétigo
• M. canis (perros y gatos). • M. gypseum (tierra) . • Trychophyton causa tiña facial, que pasa
desapercibido si uno no mira los vellos.
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TIÑA CORPORIS (TIÑA GLADAIATORUM)
• Competencias de lucha• Portadores asintomáticos• T. tonsurans
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LESIONES INFLAMATORIAS PROFUNDAS
• Hongos zoofilicos: T. verrucosum (gato)• Lesión inflamatoria elevada, rojo, pustulosa
(penetración profunda en folículo)
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TRATAMIENTO
• Aplicación tópica, 2v/d, usual desaparición en 2 semanas, se debe aplicar hasta una semana después.
• Lesión extensa o afección popular: Tx vía oral
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• Fluconazole 50 to 100 mg daily or 150 mg once weekly for 2 to 4 weeks
• Itraconazole 100 mg daily for 2 weeks or 200 mg daily for 7 days.
• Itraconazole 100 mg twice daily immediately after meals on days 1 and 8 or on days 1 and 2 may also be effective.
• Terbinafine 250 mg daily for 1 to 2 weeks is also effective.
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Tiña de la mano
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Tiña incognito
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TIÑA CRURIS:
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• Lesión anular en ingle. • Asociado con frecuencia a tiña pedis• Sospechar Candida si compromete escroto sin
afectar ingle• Agentes: T. rubrum. T. mentagrophytes, mas raro
E. floccosum.
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Diagnostico diferencialINTERTRIGO
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ERITRASMA
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TRATAMIENTO
• Lesions may appear to respond quickly, but creams should be applied twice a day for at least 10 days.
• The fungicidal allylamines (naftifine and terbinafine) and butenafine (allylamine derivative) allow for a shorter duration of treatment compared with fungistatic azoles (clotrimazole, econazole, ketoconazole, oxiconazole, miconazole, and sulconazole)
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TIÑA PEDIS
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• Mas común de las tiñas• T. rubrum, mas común (disminuye respuesta
inmunológica y recambio capa cornea)• Mas frecuente en varón• Predisposición inmunológica• El espacio interdigital que mas se afecta esta
entre el 4to y 5to dedo (se afectan todos), puede verse descamación, área blanca, húmeda, fisura, maceración.
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• Puede haber invasión bacteriana (S. aureus, epidermidis, gram negativos, corinobacterium minucitimum)
• Afección de planta o dorso, en crónico, tipo de tiña, presencia de vesículas
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SINDROME UNA MANO DOS PIES
• T. rubrum, mas frecuente• Usualmente tiña de pie + onicomicosis
preceden a afección mano
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TRATAMIENTO
• Terbinafine 1% cream (Lamisil over-the-counter) applied twice daily for 1 week results in a high cure rate in interdigital tinea pedis.
• In one series, terbinafine gave progressive mycologic improvement; at 5 weeks after treatment, 88% of the patients were clear of infection
• clotrimazole, that require 4 weeks of treatment.
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• utenafine (Mentax cream, Lotrimin Ultra over-the-counter) applied twice daily for 1 week
• Econazole nitrate (Spectazole) has activity against several bacterial species associated with severely macerated interdigital interspaces.
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• Hyperkeratotic, moccasin-type tinea of the plantar surface responds slowly to conventional therapy.
• Oral terbinafine 125 mg daily for 4 weeks produced sustained cure rates of 95%. PMID: 18076589
• Griseofulvin 250 to 500 mg twice a day for 6 weeks resulted in a 27% to 35% cure rate.
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Pitted keratolysis
• Dermatophilus congolensis yMicrococcus sedentarius .
• Producen queratinasa pitting en el estrato corneo, cuando la piel esta hidratada y a pH neutro.
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• Cambio de habitos: Lavar los pies con jabon o limpiador antibacteriano
• Clorhidrato de aluminio 20% (Drysol) twice a day. Lazerformalyde solution (10% formaldehyde),, is useful. Treatment can then be applied periodicantiperspirantally when necessary.
• Antibiotics are effective even without aluminum chloride or formaldehyde. The application twice a day of alcohol-based benzoyl peroxide may also be useful.
• Treatment with acne medications such as topical erythromycin solution or clindamycin solution is also curative.
• Mupirocin (Bactroban) ointment or cream and fusidic acid cream may also be effective.
• Oral erythromycin is an alternative.
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Acute vesicular tinea pedis
• responds to wet Burow’s solution compresses applied for 30 minutes several times each day.
• Oral antifungal drugs control the acute infection.• Secondary bacterial infection is treated with oral
antibiotics.• A vesicular id reaction sometimes occurs at distant sites• during an inflammatory foot infection. Wet dressings,• group V topical steroids, and, occasionally, prednisone• 20 mg twice a day for 8 to 10 days are required for control• of id reactions.
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• Tinea pedis has been effectively treated with pulse doses
• fluconazole 150 mg orally once weekly• Itraconazol 200 mg itraconazole daily for 2
weeks or 200 mg twice a day for 1 week.• Terbinafina 250 mg for 2 weeks.
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ONICOMICOSIS
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• Probar diagnostico con KOH o cultivo• Cultivo es importante :no todos son
dermatofitos .No todos los antifúngicos tienen igual espectro
1. Paroniquia candidiasica2. Proximal subungeal. SIDA3. Blanca superficial :T. mentagrophytes4. Distal subungeal y distrófica total : el tipo mas
común Agente etiológico mas común :T. rubrum, Candida y
mohos
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PITIRIASIS VERSICOLOR
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• Maculas redondas hiper o hipopigmentadas, pecho y espalda.
• Relacionada al sudor• Causada por proliferación de Malassezia furfur.• Hongo fácil de eliminar pero la hiperpigmentacion
persiste ( ketoconazole) • Malassezia implicada en dermatitis seborreica y
foliculitis
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Tiña nigra
• Macula negra palmar o plantar• Se confunde con melanoma• Causada por Exophiala werneckii, Hortaea
werneckii , Phaeoannelomyces werneckii • Invasión limitada al estrato corneo
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PiedraPiedra Negra Nódulos duros y negros en el pelo• Causada por Piedraia hortae
Piedra Blanca• Causada por Trichosporon beigelii• nódulos amarillentos blandos en vello axilar , genital
o cuero cabelludo