Endocardite a Nocardia ap��s Cirurgia de Substitui����o Valvular Mitral: Caso Cl��nico e Revis��o da Literatura

A Nocardia �� respons��vel por diversos tipos de infec����o quer em receptores imunocompetentes, quer imunocomprometidos e pode afectar qualquer ��rg��o. A endocardite a Nocardia spp �� muito rara e tem mau progn��stico. Segundo o nosso conhecimento e ap��s revis��o da literatura, foram reportados apenas 12 casos de endocardite a Nocardia, a maioria tratada com substitui����o valvular. Reportamos o primeiro caso descrito em Portugal de endocardite prot��sica a Nocardia, tratado com sucesso apenas com terap��utica antimicrobiana (trimetoprimsulfametoxazol), sem necessidade de substitui����o valvular.

Quantitative Analysis of Immunoglobulin E Reactivity Profiles in Patients Allergic or Sensitized to Natural Rubber Latex (Hevea Brasiliensis)

Characterized native and recombinant Hevea brasiliensis (rHev b) natural rubber latex (NRL) allergens are available to assess patient allergen sensitization profiles. OBJECTIVE: Quantification of individual IgE responses to the spectrum of documented NRL allergens and evaluation of cross-reactive carbohydrate determinants (CCDs) for more definitive diagnosis. METHODS: Sera of 104 healthcare workers (HCW; 51 German, 21 Portuguese, 32 American), 31 spina bifida patients (SB; 11 German, 20 Portuguese) and 10 Portuguese with multiple surgeries (MS) were analysed for allergen-specific IgE antibody (sIgE) to NRL, single Hev b allergens and CCDs with ImmunoCAP technology. RESULTS: In all patient groups rHev b 5-sIgE concentrations were the most pronounced. Hev b 2, 5, 6.01 and 13 were identified as the major allergens in HCW and combined with Hev b 1 and Hev b 3 in SB. In MS Hev b 1 displayed an intermediate relevance. Different sIgE antibody levels to native Hevea brasiliensis (nHev b) 2 and rHev b 6.01 allowed discrimination of SB with clinical relevant latex allergy vs. those with latex sensitization. Sensitization profiles of German, Portuguese and American patients were equivalent. rHev b 5, 6.01 and nHev b 13 combined detected 100% of the latex-allergic HCW and 80.1% of the SB. Only 8.3% of the sera showed sIgE response to CCDs. CONCLUSIONS: Hev b 1, 2, 5, 6.01 and 13 were identified as the major Hev b allergens and they should be present in standardized latex extracts and in vitro allergosorbents. CCDs are only of minor relevance in patients with clinical relevant latex allergy. Component-resolved diagnostic analyses for latex allergy set the stage for an allergen-directed immunotherapy strategy

Larva Migrans Cut��nea - a Prop��sito de um Caso Cl��nico

A larva migrans cut��nea representa uma das dermatoses mais frequentes nos turistas que regressam de pa��ses tropicais e sub-tropicais. O agente mais frequente �� a larva Ancylostoma brasiliensis que habita no intestino de c��es e gatos. Os humanos s��o afetados quando contatam com solo contaminado com os excrementos de animais infetados. Apresentamos o caso de uma professora, 39 anos de idade, natural e residente em Portugal que, ap��s regressar de f��rias no Nordeste do Brasil, refere dermatose localizada �� 4�� prega interdigital e por����o adjacente do dorso dos p��s, constitu��da por v��rias les��es eritematosas, pruriginosas, de trajecto serpiginoso, compat��veis com larva migrans cut��nea. O quadro regrediu ap��s terap��utica com Albendazol. Devido �� maior frequ��ncia de fluxos migrat��rios na atualidade, as dermatoses tropicais podem tornar-se mais frequentes nos pa��ses de clima temperado. Salienta-se a import��ncia do aconselhamento dos turistas para a preven����o desta dermatose, nomeadamente atrav��s do uso de cal��ado protetor.