Coccidioidomicosis cutánea primaria: revisión de la literatura.

La coccidioidomicosis es una micosis profunda con manifestaciones respiratorias, cutaneas o diseminadas, producida por el hongo dimorfo Coccidioides sp. Es endemica en zonas deserticas y semideserticas de California, Arizona, Mexico, Centro y Sur America hasta Argentina. En Venezuela es endemica en los estados Lara, Falcon y Zulia. La coccidioidomicosis cutanea primaria (CCP), sin manifestaciones respiratorias o sistemicas es extremadamente rara. Ocurre por inoculacion directa del hongo en la piel a traves de un traumatismo desde una fuente en el ambiente o un accidente de laboratorio. El primer caso fue descrito en 1927. En 1953 Wilson propone los criterios diagnosticos de CCP. Se realizo una revision de la literatura internacional y venezolana de todos los casos de CCP reportados hasta la actualidad. Se encontraron 43 casos en la literatura internacional y 6 en la nacional. Se analizaron las caracteristicas de estos casos, se proponen criterios clinicos, epidemiologicos y de laboratorio para su diagnostico y se realiza una extensa revision sobre el tema. Primary cutaneous coccidioidomicosis: literature review Summary Coccidioidomycosis is a deep mycosis with respiratory, cutaneous and disseminated symptoms produced by the dimorphic fungi Coccidioides sp. Endemic areas include desertic and semidesertic zones of California, Arizona Mexico, Central and South America, down to Argentina. In Venezuela, it is endemic in Lara, Falcon and Zulia states. Primary cutaneous coccidioidomycosis (PCC), without respiratory or systemic symptoms, is very rare. Traumatic inoculation of the organism into the skin results from direct contact with a source in the environment or in the laboratory. It was first described in 1927 and in 1953 Wilson proposed diagnostic criteria. We report a 27 year-old male with PPC, who was supposedly infected in a nonendemic area, the diagnosis was delayed, until a skin biopsy which evidenced the fungus. A thorough review of all the cases of PCC reported until now in the international and Venezuelan literature was performed. A total of 43 cases in the international literature and 5 cases in the Venezuelan literature were found. We analyzed these cases, propose clinical, epidemiologic and laboratory diagnostic criteria and present a comprehensive review of the subject. Keywords: coccodioidomycosis, primary cutaneous coccidioidomycosis.