Tropical mycoses diagnosed at Brazzaville University Hospital (Congo), November 1991-July 1995. Clinical and mycological appearance before, during and after treatment

Between November 1991 and July 1995, parasitologists at the Brazzaville Uni versity Hospital diagnosed two cases of rhinoentomophthoromycosis, six case s of histoplamosis due to Histoplasma capsulatum var. duboisii and one case of chromoblastomycosis in Congolese patients. The two rhinoentomophthoromy coses had a classical presentation somewhat early in the natural history of the disease. They were confirmed by histology and in both cases isolation of Conidiobolus coronatus strains. Both resolved easily with ketoconazole. In at least three of the cases, the histoplasmoses affected HIV-positive pa tients, and demonstrated all the classical clinical aspects previously desc ribed in this disease apart from two deaths by hematemesis. All were diagno sed from the isolation of yeasts in pathological specimens, and all posed d ifficult therapeutic problems. They required (where possible) alternating c ourses of ketoconazole, amphotericin B and itraconazole. Finally, the chrom oblastomycosis affected both lower limbs of a 70-year-old farm worker with typical raised lesions. It was due to Fonsecaea pedrosoi and responded well to itraconazole after failure of ketoconazole treatment. Putting these pat hologies in their current epidemiological context, the authors insist that most tropical mycoses can be diagnosed biologically, even in the unfavourab le economic climate of endemic areas, and emphasise the therapeutic difficu lties inherent in such conditions.