| Popis: |
The inoculation for the first time of many species of microbes capable of causing systemic infections through the skin of persons capable of developing locally a significant degree of specific immunologic resistance results in what is appropriately termed the primary cutaneous complex or syndrome. The resemblance to primary syphilis is so striking that the word "chancriform" has also been used. Clinically the initial papule soon becomes a relatively painless ulcer, lymphangitis develops, often with ulcerative nodules distributed along the vessels, and lymphadenopathy where this drainage reaches. There is a strong tendency toward eventual spontaneous healing of this entity, although systemic spread may take place. Sporotrichosis in its common form was established as chancriform in 1898, tuberculosis in 1926, and coccidioidomycosis in 1953. Since then, this concept has been extended by similar cases in North American blastomycosis, histoplasmosis and infections with Nocardia asteroides and N. brasiliensis . In some of the remaining deep fungous infections it may occur under special circumstances; in others, it may never occur. This stage is rare in most of these diseases, principally because the organisms do not exist in nature in a form appropriate to cause infective puncture wounds. This rarity should alert the clinician to realize that in contrast most cutaneous lesions in these disorders result from dissemination from a visceral focus and are therefore not sufficiently localized to be treated by local therapy alone. |
