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Micologia Médica Tópicos em Micologia Médica Jeferson Carvalhaes de Oliveira 4ª. Edição OLIVEIRA, Jeferson Carvalhaes de TÓPICOS em MICOLOGIA MÉDICA Rio de Janeiro 2014 Capa: Exame direto de tecido contrastado com nanquim. Criptococose, 400x Diagramação e ilustração da 1ª. Edição: Carla Vieira da Costa Revisão da 1ª. Edição: Maria Tereza Mateus Raush Apoio: Control-Lab FICHA CATALOGRÁFICA: ______________________________________________________________________________ OLIVEIRA, Jeferson Carvalhaes de. Tópicos em Micologia Médica / Jeferson Carvalhaes de Oliveira – Rio de Janeiro; 2014. 230 págs,; il. col. ISBN 85-900986-1-3 Inclui Bibliografia. 1. Tópicos em Micologia I. Título PREFÁCIO Muito honrado com o convite de nosso querido colega Prof. Jeferson Cavalhaes para que escrevesse algumas linhas sobre o Prof. Jaime de Azevedo Carneiro, um dos grandes expoentes da Micologia Médica, me chega- ram recordações dos contatos diários que mantínhamos na antiga Faculdade Nacional de Medicina, na Praia Vermelha. O nosso Prof. Jeferson Carvalhaes, hoje, doutorando do Instituto Oswaldo Cruz, era, então, na época, aluno monitor da disciplina de Parasitologia, quando escolheu, para sua atuação específica, o setor de Micologia che- fiado pelo Prof. Jaime Carneiro, homem com características humanas especiais, do qual se tornou discípulo e amigo. Jaime Carneiro culminou sua carreira universitária como Professor Titular na Universidade Federal Flumi- nense, ocupando também a chefia do laboratório de Micologia do Hospital Pedro Ernesto da UERJ. Notabili- zou-se, ainda, pela vasta colaboração científica em trabalhos referentes à patologia dos fungos. O Prof. Jaime Carneiro, por sua simplicidade, espírito crítico e expressiva atividade participativa, atraía com habilidade própria, peculiar aos homens da ciência, jovens alunos, educando pelo exemplo de dignidade e seriedade científica um grande número de estudantes que, após um período de aprendizado, passavam a ser discípulos em convivência familiar. Este exemplar Professor dedicou sua existência ao estudo dos fungos e lapidou seus sentimentos com esplên- dido desenvolvimento espiritual pela busca de verdades e coroado de extrema sabedoria. Prof. J. Ottílio Machado Prof. Titular de Parasitologia – UFF Ex-Chefe de Departamento da UFRJ PREFÁCIO (3ª. Edição) De uma maneira geral, o brasileiro lê pouco e escreve muito menos. O Professor Jeferson Carvalhaes de Oliveira é uma exceção. Publicou seu primeiro livro em 1999, agora o terceiro e seguramente outros virão, pois Jeferson é um irrequieto intelectual. Desta vez aborda atualizações do seu primeiro livro de grande interesse para a classe médica em particular para os clínicos, infectologistas, patologistas e dermatologistas. Aborda ainda com maior profundidade as micoses ocasionais e micoses raras. O autor adentra em um vasto campo de estudo envolvendo microorga- nismos conhecidos por fungos, leveduras e actinomicetos, embora este último esteja hoje classificado entre as bactérias. Após a parte introdutória, o qual se observará aspectos gerais da micologia, é feita uma análise sistemática das micoses. Este livro preenche, pois, uma lacuna, e, por isso mesmo, é motivo para nós os profissionais da saúde, congratularmos seu autor pelo esforço e dedicação no que concerne a sua publicação. Prof. Sergio Costa Lima da Silva Professor Titular de Dermatologia do Instituto de Pós-Graduação Médica Carlos Chagas Membro Titular da Academia de Medicina do Rio de Janeiro 8 Oliveira,Jeferson Carvalhaes Tópicos em Micologia Médica 9 APRESENTAÇÃO Este trabalho é uma homenagem ao Prof. Jayme de Azevedo Carneiro que durante 35 anos ensinou a micologia na área biomédica e torna-se importante em virtude da carência de textos em português desta especialidade. O Prof. Carneiro exerceu suas atividades na Faculdade de Ciências Médicas, no Laboratório de Micologia do Hospital das Clínicas da UERJ (H. Pedro Ernesto), Departamento de Parasitologia do Instituto de Ciências Biomédicas da UFRJ, Instituto Biomédico da UFF, Clínica de Dermatologia do Hosp. Univ. Antônio Pedro, UFF, onde ensinou e orientou inúmeros alunos, despertando nestes jovens o interesse pelo estudo dos fungos. Atualmente aposentado, vive em Araruama. Acompanhei o prof. durante minha vida acadêmica e hoje, também professor, tentando dar continuação aos seus ensinamentos, reuni, com sua permissão, uma parte do que ele produziu ao longo desses anos, transcrevendo para este livro. O trabalho está dividido em duas partes, sendo a primeira de explanação e a segunda de figuras. Procuramos, no texto, dar um desenvolvimento uniforme na descrição das micoses, a começar pela definição, etiologia, distribuição geográfica, seguindo-se o mecanismo de agressão, patogenia e clínica e, por fim, diagnóstico, prognóstico e trata- mento, completando-se com bibliografia. É precisamente destinado aos alunos de Ciências Médicas, aos estagiários de Laboratório de Micologia, técnicos e a todos que se interessarem pelo maravilhoso mundo dos fungos. O estudo dos fungos é tão interessante que estimula até a parte artística das pessoas, como aconteceu com minha esposa e com a do professor, a quem chamava carinhosamente de “Olivinha”. Seus desenhos estão nas páginas seguintes. Caso alguém tenha receio de adquirir alguma doença mexendo com os fungos, não se preocupe, é só visitar a Bahia. Lá existe uma “reza baiana” (Dr. Jolival Alves Soares - Inst. Análises e Pesquisas) que utiliza o ramo de uma planta para afastar e proteger contra os fungos patogênicos. Aproveito para agradecer a todos os meus colegas e alunos que, pelo seu interesse, fizeram crescer cada vez mais essa especialidade. Jeferson Carvalhaes de Oliveira 10 Oliveira,Jeferson Carvalhaes Tópicos em Micologia Médica 11 SUMÁRIO Prefácio .............................................................................................................................................. 05 Apresentação ...................................................................................................................................... 06 1 Introdução ao Estudo dos Fungos Micologia ........................................................................................................................................... 21 Histórico ............................................................................................................................................ 21 Noções Fundamentais de Classificação, Morfologia e Biologia dos Fungos .................................... 21 Noções Fundamentais de Morfologia ................................................................................................ 22 Esporos ............................................................................................................................................... 23 Noções Fundamentais de Biologia dos Fungos ................................................................................. 24 Importância do Estudo da Micologia ................................................................................................. 25 Diagnóstico de Laboratório das Micoses ........................................................................................... 28 Cultura do Material Patológico .......................................................................................................... 30 2 Micoses Superficiais Micoses Superficiais .......................................................................................................................... 36 Miselânea (Ceratofitose) Pitiríase Versicolor ............................................................................................................................. 37 Tinea Nigra ........................................................................................................................................ 43 Tricomicoses Nodulares .................................................................................................................... 46 Tricomicose Palmelina (Tricomicose Nodular, Tricomicose Axilar, Tricomicose Cromático) ......... 51 Eritrasma ............................................................................................................................................ 53 Dermatofitoses ou Tinhas (Tinea) ...................................................................................................... 56 Candidíase (Monilíase) ...................................................................................................................... 76 3 Classificação das Micoses Classificação das Micoses Profundas ................................................................................................ 88 4 Micoses Subcutâneas Esporotricose ..................................................................................................................................... 95 Cromomicose (Micose de Pedroso Lane) .......................................................................................... 103 Rinosporidiose (Micose de Seeber) ................................................................................................... 111 Blastomicose Queloidiana ou Micose de Jorge Lobo ....................................................................... 115 5 Micetomas Micetomas .......................................................................................................................................... 123 12 Oliveira,Jeferson Carvalhaes 6 Micoses Profundas ou Sistêmicas Paracoccidioidomicose (Micose de Lutz ou Blastomicose Sul Americana) ................................. 139 Histoplasmose
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