{"id":32399,"date":"2013-08-02T14:20:07","date_gmt":"2013-08-02T18:50:07","guid":{"rendered":"http:\/\/piel-l.org\/blog\/?p=32399"},"modified":"2013-08-17T12:01:19","modified_gmt":"2013-08-17T16:31:19","slug":"caso-clinico-no-62","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/32399","title":{"rendered":"Caso cl\u00ednico N\u00ba 62"},"content":{"rendered":"<p>\u00a0<em><strong>Dr. Pedro Escalona,<br \/>Lcdo. Fernando G\u00f3mez Daza.<br \/><span style=\"font-size: x-small;\">Valencia. Venezuela<\/span><\/strong><\/em><\/p>\n<p>Paciente masculino de 42 a\u00f1os de edad, natural y procedente de Mariara (20 min de Valencia), Estado Carabobo, Venezuela, refiere intervenci\u00f3n quir\u00fargica para extraerle lipoma en el muslo derecho (1998).<\/p>\n<p><!--more--><\/p>\n<p>Aproximadamente 10 a\u00f1os despu\u00e9s refiere inflamaci\u00f3n en el sitio de la cicatriz con aparici\u00f3n de n\u00f3dulos, algunos fluctuantes con trayectos fistulosos que drenan material purulento y cicatrices retr\u00e1ctiles sin dolor. Consulta por primera vez a cirujano general en el 2013 por estas lesiones, el cual toma biopsia y lo interconsulta con infect\u00f3logo y este \u00faltimo me lo refiere para estudio microbiol\u00f3gico.<\/p>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_32400\" aria-describedby=\"caption-attachment-32400\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/01.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32400\" alt=\"Fig. 1: Cicatriz superior fue la del lipoma (1998) y la inferior de la biopsia (2013)\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/01-390x292.jpg\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/01-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/01.jpg 1024w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32400\" class=\"wp-caption-text\">Fig. 1: Cicatriz superior fue la del lipoma (1998) y la inferior de la biopsia (2013)<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_32401\" aria-describedby=\"caption-attachment-32401\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/02.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32401\" alt=\"Fig. 2\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/02-390x292.jpg\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/02-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/02.jpg 1024w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32401\" class=\"wp-caption-text\">Fig. 2<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_32402\" aria-describedby=\"caption-attachment-32402\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/03.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32402\" alt=\"Fig.3\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/03-390x292.jpg\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/03-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/03.jpg 1024w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32402\" class=\"wp-caption-text\">Fig.3<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_32403\" aria-describedby=\"caption-attachment-32403\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/04.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32403\" alt=\"Fig.4\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/04-390x292.jpg\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/04-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/04.jpg 1024w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32403\" class=\"wp-caption-text\">Fig.4<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_32404\" aria-describedby=\"caption-attachment-32404\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/05.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32404\" alt=\"Fig.5\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/05-390x292.jpg\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/05-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/05.jpg 1024w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32404\" class=\"wp-caption-text\">Fig.5<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<p><em>Caso presentado previo consentimiento informado del paciente<\/em><\/p>\n<p>&nbsp;<\/p>\n<p><strong>\u00bfCu\u00e1les ser\u00edan sus diagn\u00f3sticos presuntivos? En la pr\u00f3xima entrega seguiremos desgranando el caso.<\/strong><\/p>\n<p>&nbsp;<\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n<p><span style=\"font-size: large;\"><strong>2\u00aa Parte:<a name=\"parte2\"><\/a><\/strong><\/span><\/p>\n<p>Se realiz\u00f3 toma de muestra de las f\u00edstulas por d\u00edgito presi\u00f3n con mucha firmeza debido a lo p\u00e9treo de la zona obteniendo un material sanguinolento con conglomerados de granos, blandos, blanco-amarillentos de gran tama\u00f1o.<\/p>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_32566\" aria-describedby=\"caption-attachment-32566\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/micopiel-62-fig-6.png\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32566\" alt=\"Fig. 6: Conglomerados de granos, blandos, blanco-amarillentos de gran tama\u00f1o\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/micopiel-62-fig-6-390x292.png\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/micopiel-62-fig-6-390x292.png 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/micopiel-62-fig-6-1024x768.png 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/micopiel-62-fig-6.png 1039w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32566\" class=\"wp-caption-text\">Fig. 6: Conglomerados de granos, blandos, blanco-amarillentos de gran tama\u00f1o<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_32567\" aria-describedby=\"caption-attachment-32567\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/micopiel-62-fig-7.png\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32567\" alt=\"Fig. 7: Se tom\u00f3 muestra con asa est\u00e9ril para estudio microbiol\u00f3gico\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/micopiel-62-fig-7-390x292.png\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/micopiel-62-fig-7-390x292.png 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/micopiel-62-fig-7-1024x768.png 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/micopiel-62-fig-7.png 1039w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32567\" class=\"wp-caption-text\">Fig. 7: Se tom\u00f3 muestra con asa est\u00e9ril para estudio microbiol\u00f3gico<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_32568\" aria-describedby=\"caption-attachment-32568\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/micopiel-62-fig-8.png\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32568\" alt=\"Fig. 8: Debido a la gran cantidad de granos se colect\u00f3 en tubos de ensayo con soluci\u00f3n salina y formol para su conservaci\u00f3n\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/micopiel-62-fig-8-390x292.png\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/micopiel-62-fig-8-390x292.png 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/micopiel-62-fig-8-1024x768.png 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/micopiel-62-fig-8.png 1039w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32568\" class=\"wp-caption-text\">Fig. 8: Debido a la gran cantidad de granos se colect\u00f3 en tubos de ensayo con soluci\u00f3n salina y formol para su conservaci\u00f3n<\/figcaption><\/figure>\n<p><strong>Pregunta al Foro:<\/strong><\/p>\n<ul>\n<li><strong>\u00bfPor las caracter\u00edsticas cl\u00ednicas y la presencia de granos se puede confirmar qu\u00e9 estamos ante un caso cl\u00ednico de Micetoma?<\/strong><\/li>\n<li><strong>\u00bfSe puede presumir el tipo de Micetoma y\/o agente etiol\u00f3gico por el tipo de grano obtenido?<\/strong><\/li>\n<li><strong>En la pr\u00f3xima entrega se publicar\u00e1 el estudio microbiol\u00f3gico de estos granos.<\/strong><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n<p><span style=\"font-size: large;\"><strong>3ra Parte<a name=\"parte3\"><\/a><\/strong><\/span><\/p>\n<p><strong>Estudio microbiol\u00f3gico y citol\u00f3gico<\/strong><\/p>\n<figure id=\"attachment_32593\" aria-describedby=\"caption-attachment-32593\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/09.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32593\" alt=\"Fig. 9: Grano blando, blanco-amarillento de gran tama\u00f1o sobre l\u00e1mina portaobjeto est\u00e9ril\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/09-390x343.jpg\" width=\"390\" height=\"343\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/09-390x343.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/09.jpg 1024w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32593\" class=\"wp-caption-text\">Fig. 9: Grano blando, blanco-amarillento de gran tama\u00f1o sobre l\u00e1mina portaobjeto est\u00e9ril<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_32592\" aria-describedby=\"caption-attachment-32592\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/10.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32592\" alt=\"Fig. 10: Se aplana el grano con otra l\u00e1mina portaobjeto est\u00e9ril, este procedimiento se puede realizar con otros granos y l\u00e1minas, y el material que queda aplanado se utiliza para observaci\u00f3n macrosc\u00f3pica, estudio citol\u00f3gico y cultivo\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/10-390x306.jpg\" width=\"390\" height=\"306\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/10-390x306.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/10.jpg 1024w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32592\" class=\"wp-caption-text\">Fig. 10: Se aplana el grano con otra l\u00e1mina portaobjeto est\u00e9ril, este procedimiento se puede realizar con otros granos y l\u00e1minas, y el material que queda aplanado se utiliza para observaci\u00f3n macrosc\u00f3pica, estudio citol\u00f3gico y cultivo<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_32591\" aria-describedby=\"caption-attachment-32591\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/11.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32591\" alt=\"Fig. 11: Detalle del grano aplanado\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/11-390x458.jpg\" width=\"390\" height=\"458\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/11-390x458.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/11.jpg 871w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32591\" class=\"wp-caption-text\">Fig. 11: Detalle del grano aplanado<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_32594\" aria-describedby=\"caption-attachment-32594\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/12.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32594\" alt=\"Fig. 12: A otros granos se le realiza observaci\u00f3n microsc\u00f3pica y en esta ocasi\u00f3n se utiliz\u00f3 hidr\u00f3xido de potasio al 10% (40x)\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/12-390x291.jpg\" width=\"390\" height=\"291\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/12-390x291.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/12.jpg 1024w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32594\" class=\"wp-caption-text\">Fig. 12: A otros granos se le realiza observaci\u00f3n microsc\u00f3pica y en esta ocasi\u00f3n se utiliz\u00f3 hidr\u00f3xido de potasio al 10% (40x)<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_32595\" aria-describedby=\"caption-attachment-32595\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/13.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32595\" alt=\"Fig. 13: Examen directo con KOH 10% (100x)\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/13-390x292.jpg\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/13-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/13.jpg 1024w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32595\" class=\"wp-caption-text\">Fig. 13: Examen directo con KOH 10% (100x)<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_32596\" aria-describedby=\"caption-attachment-32596\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/14.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32596 \" alt=\"Fig. 14: Examen directo con KOH 10% con luz indirecta para observar el relieve de los granos (100x)\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/14-390x292.jpg\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/14-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/14.jpg 1024w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32596\" class=\"wp-caption-text\">Fig. 14: Examen directo con KOH 10% con luz indirecta para observar el relieve de los granos (100x)<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_32597\" aria-describedby=\"caption-attachment-32597\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/15.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32597\" alt=\"Fig. 15: Examen directo con KOH 10%, detalle de los flecos (400x)\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/15-390x292.jpg\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/15-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/15.jpg 1024w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32597\" class=\"wp-caption-text\">Fig. 15: Examen directo con KOH 10%, detalle de los flecos (400x)<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_32598\" aria-describedby=\"caption-attachment-32598\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/16.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32598\" alt=\"Fig. 16: Coloraci\u00f3n de Gram (1000x)\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/16-390x292.jpg\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/16-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/16.jpg 1024w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32598\" class=\"wp-caption-text\">Fig. 16: Coloraci\u00f3n de Gram (1000x)<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_32599\" aria-describedby=\"caption-attachment-32599\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/17.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32599\" alt=\"Fig. 17: Coloraci\u00f3n de Ziehl-Neelsen (1000x)\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/17-390x292.jpg\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/17-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/17.jpg 1024w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32599\" class=\"wp-caption-text\">Fig. 17: Coloraci\u00f3n de Ziehl-Neelsen (1000x)<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<p><strong>Preguntas al Foro:<\/strong><\/p>\n<ul>\n<li><strong>\u00bfQu\u00e9 tipo de Micetoma presenta el paciente?<\/strong><\/li>\n<li><strong>\u00bfPor las caracter\u00edsticas morfol\u00f3gicas y tintoriales de los granos se puede presumir el agente etiol\u00f3gico?<\/strong><\/li>\n<li><strong>\u00bfQu\u00e9 medios de cultivos elegir\u00eda usted para aislar dicho agente etiol\u00f3gico?<\/strong><\/li>\n<li><strong>En la pr\u00f3xima entrega se publicar\u00e1 el microorganismo cultivado y as\u00ed concluir el caso cl\u00ednico.<\/strong><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n<p><span style=\"font-size: large;\"><strong>4\u00aa Parte<a name=\"parte4\"><\/a><\/strong><\/span><\/p>\n<p>En esta entrega env\u00edo las im\u00e1genes del microorganismo aislado.<\/p>\n<p>Primero, es oportuno explicar que siguiendo las claves nemot\u00e9cnicas de los micetomas con respecto a las variables cl\u00ednica y caracter\u00edsticas de los granos se puede concluir que estamos ante un caso cl\u00ednico de Actinomicetoma por Actninomadura madurae. Segundo, esta bacteria es de dif\u00edcil crecimiento tanto que muchos investigadores no han podido aislarla de muestras cl\u00ednicas debido a requiere de medios de cultivos selectivos y enriquecidos como el de L\u00f6wenstein-Jensen.<\/p>\n<p>Los granos triturados se cultivaron en una bater\u00eda de agares Sabouraud con y sin antibi\u00f3ticos, Micosel y gracias al consejo oportuno de Alexandro Bonifaz en un medio de cultivo sencillo y econ\u00f3mico como el agar Agua de Coco, todos a temperatura ambiente y a 37\u00baC. Solo hubo crecimiento a partir del 6to d\u00eda de incubaci\u00f3n en agar Agua de Coco y a 37\u00baC, por ahora, hasta los 18 d\u00edas de incubaci\u00f3n (16-08-2013) no hay crecimiento en los dem\u00e1s medios de cultivo.<\/p>\n<p>A continuaci\u00f3n dichas im\u00e1genes del cultivo.<\/p>\n<figure id=\"attachment_32604\" aria-describedby=\"caption-attachment-32604\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/19-Cultivo-9-dias-01.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32604\" alt=\"Fig. 19: 6 d\u00edas de incubaci\u00f3n en agar Agua de Coco a 37\u00baC\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/19-Cultivo-9-dias-01-390x292.jpg\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/19-Cultivo-9-dias-01-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/19-Cultivo-9-dias-01-1024x768.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/19-Cultivo-9-dias-01.jpg 1240w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32604\" class=\"wp-caption-text\">Fig. 19: 6 d\u00edas de incubaci\u00f3n en agar Agua de Coco a 37\u00baC<\/figcaption><\/figure>\n<figure id=\"attachment_32605\" aria-describedby=\"caption-attachment-32605\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/20-Cultivo-18-dias-01.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32605\" alt=\"Fig. 20: 18 d\u00edas de incubaci\u00f3n en agar Agua de Coco a 37\u00baC\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/20-Cultivo-18-dias-01-390x292.jpg\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/20-Cultivo-18-dias-01-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/20-Cultivo-18-dias-01-1024x767.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/20-Cultivo-18-dias-01.jpg 1240w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32605\" class=\"wp-caption-text\">Fig. 20: 18 d\u00edas de incubaci\u00f3n en agar Agua de Coco a 37\u00baC<\/figcaption><\/figure>\n<figure id=\"attachment_32606\" aria-describedby=\"caption-attachment-32606\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/21-Cultivo-18-dias-03.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-32606\" alt=\"Fig. 21: 18 d\u00edas de incubaci\u00f3n en agar Agua de Coco a 37\u00baC, detalle de la colonia\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2013\/08\/21-Cultivo-18-dias-03-390x292.jpg\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/21-Cultivo-18-dias-03-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/21-Cultivo-18-dias-03-1024x768.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2013\/08\/21-Cultivo-18-dias-03.jpg 1240w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-32606\" class=\"wp-caption-text\">Fig. 21: 18 d\u00edas de incubaci\u00f3n en agar Agua de Coco a 37\u00baC, detalle de la colonia<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<p><strong>Preguntas al Foro:<\/strong>\u00a0<\/p>\n<p><strong>\u00bfEstamos en presencia de un Actinomadura maduare, una variante de \u00e9sta u otra especie?<\/strong><\/p>\n<p><strong>En la pr\u00f3xima entrega se publicar\u00e1 resultados de pruebas enzim\u00e1ticas y tintoriales del microorganismo aislado.<\/strong><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Refiere inflamaci\u00f3n en el sitio de la cicatriz con aparici\u00f3n de n\u00f3dulos, algunos fluctuantes con trayectos fistulosos que drenan material purulento y cicatrices retr\u00e1ctiles sin dolor<\/p>\n","protected":false},"author":7,"featured_media":32400,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,13],"tags":[],"class_list":["post-32399","post","type-post","status-publish","format-standard","has-post-thumbnail","","category-secciones-de-colaboradores","category-micopiel"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/32399","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/comments?post=32399"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/32399\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media\/32400"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=32399"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=32399"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=32399"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}