New aspects of some endemic mycoses

The treatment of mycetomas varies according to their etiological agents and the clinical state of the patient. For the treatment of eumycetomas, the a zole derivatives are the drugs of choice, with itraconazole rendering bette r results than ketoconazole and presenting better tolerance. Actinomycetoma s are treated according to different therapeutic schemes: dapsone plus sulf amethoxazol-trimethoprim (SMT), and streptomycin or amikacin or amoxicillin plus clavulanic acid. The first therapeutic scheme is very useful in the t reatment of Nocardia mycetoma, while the association of amikacin plus SMT i s the best treatment for those cases produced by Actinomadura madurae. Cipr ofloxacin is a very useful drug for the treatment of actinomycotic mycetoma s with bone lesions. Although there are several criteria for evaluating cli nical outcome there is no accepted criterion of cure. During the 1990s, the re was a remarkable increase in the incidence of coccidioidomycosis in Cali fornia, USA. An almost ten-fold increase in the number of cases was registe red during 1992 and 1993 over the usual incidence. A gradual reduction in c occidioidomycosis cases was observed in the late 1990s, This particular coc cidioidomycosis outbreak took place in areas of low endemicity, as well as in those of usual high endemicity. Among the factors believed to have influ enced this phenomenon were a drought followed by abundant winter/spring rai nfall, increased immigration of susceptible individuals, increase in excava tion/construction work and a better diagnosis of the infection, particularl y in the last part of the decade. The majority of patients presented the us ual clinical manifestations of symptomatic primary infection but an unusual number of cases with acute respiratory failure were observed.