Onychomycosis is a fungal infection of the nails with broad aetiological scope, and it represents 18-40% of all onychopathies and 39% of all superficial mycotic infections. From July 1996 to December 1999, samples of nails were collected from 588 patients with presumptive diagnosis of onychomycosis at the Dermatology and Mycology Divisions EPM\UNIFESP, Brazil, and the diagnosis was confirmed in 247 of these cases. The most common pathogens isolated in this study were yeasts in 52% of positive cultures (Candida albicans 18.3%, Candida parapsilosis 13.8%, other species of Candida 15.4% and other yeasts 4.6%), followed by dermatophytes in 40.6% of positive cultures (the most commonly isolated organisms were Trichophyton rubrum in 33.2%, followed by Trichophyton mentagrophytes in 6.3% and others 1.2%). Non-dermatophyte moulds were isolated in 7.4% of positive cultures (Fusarium spp. 4.5%, Nattrassia mangiferae 2.3% and Aspergillus spp. 0.6%). Distal and lateral subungual onychomycosis (DLSO) was the commonest clinical pattern 44.6% followed by free edge onycholysis (FEO) 38.8% and others. In conclusion, this study demonstrated that T. rubrum is the main agent causing onychomycosis in toenails, and species of genus Candida were the main agents isolated in fingernail onychomycosis in our region.

Fusarium species are common soil saprophytes and plant pathogens that have been frequently reported as etiologic agents of opportunistic infections in humans. We report eight cases of onychomycosis caused by Fusarium solani (4) and Fusarium oxysporum (4) in São Paulo, Brazil. These species were isolated from toenails in all cases. The infections were initially considered to be caused by dermatophytes. The clinical appearance of the affected toenails was leukonychia or distal subungual hyperkeratosis with yellowish brown coloration. The eight cases reported here suggest that Fusarium spp. should be taken into consideration in the differential diagnosis of tinea unguium.

Mycobaterium leprae infection was investigated in armadillos from

We describe two patients who underwent cardiac transplantation for chronic cardiomyopathy of Chagas' disease, and in whom the disease was reactivated with the development of cutaneous lesions. In both cases, the skin lesions regressed completely after 2 months of therapy with allopurinol.

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We describe a rare case of a subcutaneous infection by both Phaeoacremonium venezuelense and Plectophomella sp. in a Brazilian male. Sequencing of a ␤-tubulin gene fragment allowed us to confirm the identification of the former. However, a similar procedure of sequencing rRNA gene fragments was not useful for the identification of the latter fungus. CASE REPORTA 28-year-old Brazilian male was diagnosed with chronic myeloid leukemia in 2001. He underwent a bone marrow transplant in July 2002, but after 1 month he developed a graft-versus-host disease that compromised the skin and liver. After that, he started taking cyclosporine, mycophenolate mofetil, and prednisone. In 2004, he presented with several soft, erythematous nodules arranged in a linear distribution on the right arm (Fig. 1A) and two nodules forming a plaque lesion with fibrous consistency on the left knee ( Fig. 2A). Three serial biopsies of both lesions were taken on different days for histopathological and microbiological study. The direct examination on KOH did not reveal any type of fungal structure. Grocott and periodic acid Schiff stains revealed the presence of dematiaceous hyphae in the two types of lesions (Fig. 1B and 2B, respectively). Cultures on routine media for bacteria and fungi showed the presence of a single fungus in the samples from the leg and another, different fungus in the samples from the arm. Infections were diagnosed as subcutaneous mycoses, and the fungi were sent to the Medical School at the Universitat Rovira i Virgili for identification. The lesions were surgically removed. Since the patient showed hepatic and renal dysfunctions and general deterioration, antifungal treatment was not initiated. The patient subsequently moved to another city and was lost to follow-up.The two isolates were cultured on routine media for fungi. On the basis of its morphological features (i.e., darkly pigmented colonies and phialidic conidiogenous cells with conspicuous collarettes), the fungus isolated from the arm lesions was identified as a Phaeoacremonium sp. strain CBS 120024.On malt extract agar (Difco Laboratories, Detroit, Mich.), its colonies were camel to sunburn color, attained a diameter of 47 to 50 mm in 2 weeks at 25°C, and were able to grow at 40°C. Microscopically, it showed short and usually unbranched conidiophores, bearing an elongate ampulliform attenuated at the base or subcylindrical conidiogenous cells, often 9 to 17 m long by 1 to 2.5 m wide, from which fusiform-ellipsoidal hyaline conidia that were 3 to 6 m long by 1 to 1.5 m wide were produced (Fig. 1C). Conidiogenous cells with two apertures (polyphialides) were also present. Hyphae from aerial mycelium were verruculose, with warts not exceeding 2 m wide. Following the morphological criteria given by Mostert et al. (7) to recognize Phaeoacremonium species, we were not able to identify our isolate at the species level, so we used the molecular method proposed by the same authors. A fragment of the ␤-tubulin (tub2) gene defined by primers BT2-F and BT2-R (2) was amp...

An improvement in immune status and the use of HAART were the most important prognostic features.