Erythema nodosum: prospective study of 32 cases

The results of 32 cases studied lead us to the conclusion that erythema nodosum's investigation routine is very important, once in our retrospective study, the percentage of cases of unknown etiology was 69.4%, and in this prospective study it is 21.8%. In 10 cases (31.2%), more than one causing agent was suspected. Infections (bacterial, helminthic, fungal, by protozoa) were diagnosed in 26 cases, streptococcal infection having predominated (12 cases). Drugs-dipirone, aspirin, anovulatory - were suspected as causing agents in 13 cases. The association of erythema nodosum and histoplasmosis capsulata is described for the first time in Brazil. We consider erythema nodosum to be a complex syndrome which should be regarded as a manifestation of underlying diseases. The fact that all 32 subjects were women, 26 of them during menacme, suggests that particular hormonal media may favor the action of various processes (infections and drugs), precipitating erythema nodosum's clinical picture.

Immunological status of ENL (Erythema Nodosum Leprosum) patients: its relationship to bacterial load and levels of circulanting IL-2R

Recent data suggest that the clinical course of reactional states in leprosy is closely related to the cytokine profile released locally or systemically by the patients. In the present study, patients with erythema nodosum leprosum (ENL) were grouped according to the intensity of their clinical symptoms. Clinical and immunological aspects of ENL and the impact of these parameters on bacterial load were assessed in conjunction with patients' in vitro immune response to mycobacterial antigens. In 10 out of the 17 patients tested, BI (bacterial index) was reduced by at least 1 log from leprosy diagnosis to the onset of their first reactional episode (ENL), as compared to an expected 0.3 log reduction in the unreactional group for the same MDT (multidrug therapy) period. However, no difference in the rate of BI reduction was noted at the end of MDT among ENL and unreactional lepromatous patients. Accordingly, although TNF-alpha (tumor necrosis factor) levels were enhanced in the sera of 70.6% of the ENL patients tested, no relationship was noted between circulating TNF-alpha levels and the decrease in BI detected at the onset of the reactional episode. Evaluation of bacterial viability of M. leprae isolated from the reactional lesions showed no growth in the mouse footpads. Only 20% of the patients demonstrated specific immune response to M. leprae during ENL. Moreover, high levels of soluble IL-2R (interleukin-2 receptor) were present in 78% of the patients. Circulating anti-neural (anti-ceramide and anti-galactocerebroside antibodies) and anti-mycobacterial antibodies were detected in ENL patients' sera as well, which were not related to the clinical course of disease. Our data suggest that bacterial killing is enhanced during reactions. Emergence of specific immune response to M. leprae and the effective role of TNF-alpha in mediating fragmentation of bacteria still need to be clarified.

Análise do número de cerdas internas do órgão de Haller de larvas de Amblyomma nodosum Neumann (Acari, Ixodidae)

A partir de teleógina de Amblyomma nodosum Neumann, 1899, removida de Tamandua tetradactyla (Linnaeus, 1758) foram obtidas posturas que originaram larvas, em condições de laboratório. Um total de 219 larvas foi examinado em microscopia de luz, com objetiva de imersão e microscopia de confocal com varredura a laser. Buscou-se analisar a variação do número das cerdas internas dos lados direito e esquerdo, no fundo da cápsula do Órgão de Haller, com intuito de utilizá-las como um parâmetro quetotáxico na diagnose específica. A média do número de cerdas foi 5,06±0, 71, com valores limites da amplitude de 4-11.

Ascophyllum nodosum in the diet of tilapia (Oreochromis niloticus) and its effect after inoculation of Aeromonas hydrophila

The objective of this study was to evaluate the effect of Ascophyllum nodosum brown seaweed meal (FAM) on the health of Nile tilapia submitted to inoculation with Aeromonas hydrophila. The experiment was conducted for a period of 40 days using 120 Nile tilapia fingerlings, with age of 40 days, distributed in 20 tanks. A diet including Ascophyllum nodosum seaweed meal at 20g.kg-1 and a control diet (without FAM) were provided which constituted the treatments. Thirty days after beginning the experiment, A. hydrophila was inoculated by bacterial inoculum diluted in sterile saline solution at a concentration of 10(6) CFU ml-1. Except for the width, which was greater for the treatment with the provision of FAM (P<0.05), there was no influence on the performance parameters of the fingerlings, but the occurrence of lesions in animals inoculated with A. hydrophila and fed with FAM was lower and they also exhibited a decline in the lesions in a shorter period of time than the control group. FAM prevents hepatopancreatic congestion in infected animals. Ascophyllum nodosum brown seaweed meal reduced the number of lesions in fish in a shorter time when compared to the control group.

Avaliação de extrato de algas no progresso temporal da mancha de Mycosphaerella em cultivares de morangueiro

Em morangueiros, a mancha das folhas, causada por Mycosphaerella fragariae, é uma das doenças mais comuns na cultura, o que torna importantes os estudos de controle alternativo e de cultivares, sobre o progresso da epidemia. Em busca de práticas alternativas para seu controle, avaliou-se o efeito de cultivares de morangueiro e do extrato da alga Ascophyllum nodosum, na expressão dos sintomas de mycosphaerella, além de avaliar o ajuste de modelos de crescimento para o progresso temporal da incidência e severidade da doença. Utilizou-se o extrato de algas a 29%, na dose de 2 L ha-1, aplicado no solo, na folha e em ambos. As cultivares Dover, Toyonoka, Albion, Camarosa, Ventana, Campinas, Tudla e Camino Real foram avaliadas, quinzenalmente, quanto a incidência e severidade da doença. Utilizou-se o delineamento inteiramente casualizado, com parcelas subdivididas e três repetições. Com os dados de incidência e severidade, calculou-se a área abaixo da curva de progresso da doença e utilizou-se a análise de variância para avaliar o efeito de cultivares e do extrato de algas. Aos dados do progresso temporal da incidência e da severidade, em cada cultivar, foram ajustados os modelos monomolecular, logístico e de Gompertz. O extrato de algas não apresentou efeito ou interação com cultivares, no controle da mycosphaerella. Houve efeito de cultivar com menor intensidade da doença, em Albion e Ventana, devido, principalmente, ao atraso na epidemia, pela redução do inóculo inicial efetivo. Aos dados de progresso temporal da incidência e da severidade ajustaram-se, respectivamente, os modelos logístico e monomolecular, para todas as cultivares.

Alteração do crescimento e dos teores de nutrientes com utilização de fertilizante organomineral em cenoura

O uso de fertilizantes organominerais contendo extratos de algas é recente no Brasil. Em vista disso, este estudo teve como objetivo avaliar o efeito da aplicação foliar de fertilizante organomineral contendo extrato da alga Ascophyllum nodosum (Activo®) no desenvolvimento e nos teores de nutrientes em cenoura. O experimento foi conduzido na área de olericultura da Universidade Federal do Paraná, no município de Pinhais, PR, no ano de 2009, em sistema orgânico, utilizando cultivar do tipo Nantes. O delineamento experimental foi inteiramente casualizado, e os tratamentos consistiram na aplicação de fertilizante organomineral à base de extrato de algas. Foi utilizado um esquema fatorial com duas doses (0,2 e 0,4%) e duas épocas de aplicação (25 e 45 dias após o plantio), e um tratamento testemunha. As aplicações aumentaram a altura da parte aérea, o diâmetro radicular e o número de folhas, sendo esta variável também influenciada pela concentração. A produtividade aumentou com a aplicação do fertilizante organomineral, independentemente da concentração e da época de aplicação. Os teores nutricionais na parte aérea e nas raízes também foram alterados em decorrência das aplicações, sendo observada diminuição dos teores foliares de Cu e dos teores radiculares de N, Ca, Mg, Cu e Zn, possivelmente em função de efeito de diluição, pelo incremento da biomassa. Conclui-se que a aplicação do fertilizante organomineral contendo extrato de algas foi benéfica ao crescimento, desenvolvimento e produção das plantas de cenoura, o que resultou em diminuição na concentração de N, Ca, Mg, Cu e Zn na raiz e de Cu na parte aérea.

Mycobacterial subcutaneous arteritis

The authors report three patients with subcutaneous erythematous nodules in different phases of development, inespecific systemic symptoms, positive PPD test, and normal chest X-rays. The histopathological study of the older nodules showed a granulomatous arteritis with a few acid-fast bacilli in the vascular wall. The nodules at an early phase showed an inespecific panniculitis with some acid-fast bacilli in apparently normal cutaneous vessels. These findings suggest that the mycobacterium has a vascular tropism and may cause a primary granulomatous arteritis.

REACTIONAL STATES IN MULTIBACILLARY HANSEN DISEASE PATIENTS DURING MULTIDRUG THERAPY

It is well known that reactions are commonplace occurrences during the course of leprosy disease. Stigmatization may even be attributable to reactions which are also responsible for the worsening of neural lesions. A cohort of 162 newly-diagnosed baciloscopically positive patients from the Leprosy Care Outpatient Clinic of the Oswaldo Cruz Foundation (FIOCRUZ) was selected for this study. While 46% of the multibacillary (MB) patients submitted to the 24 fixed-dose multidrug therapy (MDT) regimen suffered reactions during treatment, it was found that all MBs were susceptible and that constant attention and care were required at all times. Fourteen per cent were classified as BB, 52% as BL, and 33% as LL. None of the variables under study, such as, sex, age, clinical form, length of illness, length of dermatological lesions, baciloscopic index (BI), or degree of disability proved to be associate with reaction among the patients studied. Reversal Reaction (RR) occurred in 45%, and Erythema Nodosum Leprosum (ENL) occurred in 55%. Among BB patients who developed reactions (15 patients), 93% presented RR; while among the LL patients who developed reactions (34 patients), 91% presented ENL. Likewise, ENL was very frequent among those with disseminate lesions, while RR was most often observed in patients with segmentary lesions. RR was also most likely to occur during the initial months of treatment. It was demonstrated that the recurrence rate of ENL was significantly higher than that of RR. Neither grade of disability nor BI was shown to be associated with RR and ENL reaction. However, the RR rate was significantly higher among patients showing BI < 3, while ENL predominated among those patients with BI > 3.

Atypical presentation of sporotrichosis: report of three cases

Sporotrichosis occurs after fungal implantation of Sporothrix spp. in the skin, and is the main subcutaneous mycosis in Latin America. Here we describe three atypical cases of the disease. The first case report an extra-cutaneous occurrence of the disease with joint infection; the second one describes a patient with bilateral lymphocutaneous form of sporotrichosis; and the third shows a zoonotic cutaneous case with the development of an erythema nodosum as a hypersensitivity reaction. These cases show the disease importance on the region and the necessity of fungal culture to the diagnosis confirmation.

Involvement of C4 allotypes in the pathogenesis of human diseases

The complement system is an important humoral defense mechanism that plays a relevant role against microbial agents, inflammatory response control, and immunocomplex clearance. Classical complement pathway activation is antibody-dependent. The C4 component participates in the initial step of activation, and C4 expression is determined by 2 pairs of allotypes: C4A and C4B. Deficiencies in C4 allotypes have been associated with several diseases. The aim of the present review is evaluate the reported data in the literature regarding specific C4A and C4B deficiencies and characterize their clinical relevance. We searched the MEDLINE and LILACS databases. Papers referring to total C4 deficiency without allotype evaluation and case reports of primary C4 deficiency were not included. Deficiencies in C4 allotypes have been associated with Mycobacterium leprae infection, erythema nodosum, systemic sclerosis with anti-topoisomerase I antibodies, intermediate congenital adrenal hyperplasia with DR5 genotype, diabetes mellitus type 1 with DR3,4 genotype, and diabetes mellitus with antibodies against islet cells. C4 allotype deficiency is also related to C4B deficiency and autoimmune-associated diseases, such as systemic lupus erythematosus, or diseases with an autoimmune component, such as autism. Some reports associate C4A with thyroiditis after delivery as well as limited and systemic sclerosis without anti-topoisomerase I antibodies. However, the studies with C4A and C4B have been concentrated in isolated populations, and some of the studies could not be reproduced by other authors.

A review of the ticks (Acari, Ixodida) of Brazil, their hosts and geographic distribution - 1. The State of Rio Grande do Sul, Southern Brazil

A review of the ticks (Acari, Ixodida) of the State of Rio Grande do Sul, southern Brazil, was completed as a step towards a definitive list (currently indicated as 12) of such species, their hosts and distribution. The ticks: Argas miniatus (poultry), Ixodes loricatus (opossums), Amblyomma aureolatum (dogs), A. calcaratum (anteaters), A. cooperi (capybaras), A. nodosum (anteaters), A. tigrinum (dogs) (Neotropical) and Rhipicephalus sanguineus (dogs) (introduced, cosmopolitan, Afrotropical) were confirmed as present, in addition to the predominant, Boophilus microplus (cattle) (introduced, pan-tropical, Oriental). Of the further 18 species thus far reported in the literature as present in the state, but unavailable for examination: only Ornithodoros brasiliensis (humans and their habitations) (Neotropical), Ixodes affinis (deer) (Nearctic/Neotropical) and I. auritulus (birds) (Nearctic/Neotropical/Afrotropical/ Australasian) are considered likely; 13 species would benefit from corroborative local data but the majority appear unlikely; reports of A. maculatum (Nearctic/Neotropical, but circum-Caribbean) are considered erroneous; the validity of A. fuscum is in doubt. The very recent, first known report of the tropical Anocentor nitens (horses)(Nearctic/Neotropical), but still apparent absence of the tropical A. cajennense (catholic) (Nearctic/Neotropical) and the sub-tropical/temperate Ixodes pararicinus (cattle) (Neotropical) in Rio Grande do Sul are important for considerations on their current biogeographical distribution and its dynamics in South America. The state has relatively long established, introduced ("exotic"), Old World tick species (B. microplus, R. sanguineus) that continue to represent significant pests and disease vectors to their traditional, introduced domestic animal hosts, cattle and urban dogs. There are also indigenous, New World ticks (A. miniatus, O. brasiliensis, A. aureolatum, A. nitens), as both long established and possibly newly locally introduced species in the state, that should be considered as potential and emergent pests and pathogen vectors to humans and their more recently acquired, introduced domestic animal hosts; rural poultry, dogs and horses.

Erythema multiforme in leprosy

The clinical course of leprosy is often interrupted by reactions, which are acute inflammatory episodes that can be classified as type I or type II. Type II reactions can present as cutaneous lesions that resemble erythema multiforme (EM). EM is classically associated with drug allergies or pre-existing viral infections. However, the differential diagnostic criteria of the diverse causative agents remain controversial. The aim of this study was to determine both the clinical relevance and the morphological and immunohistochemical characteristics of the EM-like lesions during the course of type II leprosy reactions. Twenty-seven skin biopsies were taken from typical EM-like lesions of multibacillary patients and reviewed; their histological features were correlated to their clinical aspects. Then, a computer-assisted morphometric analysis was performed to measure the extent of angiogenesis during these acute episodes. The histopathological and immunohistochemical analysis of the EM lesions revealed that they shared the same features that have been previously described for ENL, including immunopositivity in the identical cell-mediated immune markers. Our results point to leprosy as the cause of the EM-like lesions in our patients. Therefore, leprosy should be considered in the differential diagnosis of EM.

Genetics of leprosy reactions: an overview

Type-1 (T1R) and Type-2 (T2R) leprosy reactions (LR), which affect up to 50% of leprosy patients, are aggressive inflammatory episodes of sudden onset and highly variable incidence across populations. LR are often diagnosed concurrently with leprosy, but more frequently occur several months after treatment onset. It is not uncommon for leprosy patients to develop recurring reactional episodes; however, they rarely undergo both types of LR. Today, LR are the main cause of permanent disabilities associated with leprosy and represent a major challenge in the clinical management of leprosy patients. Although progress has been made in understanding the immunopathology of LR, the factors that cause a leprosy patient to suffer from LR are largely unknown. Given the impact that ethnic background has on the risk of developing LR, host genetic factors have long been suspected of contributing to LR. Indeed, polymorphisms in seven genes [Toll-like receptors (TLR)1, TLR2, nucleotide-binding oligomerisation domain containing 2, vitamin D receptor, natural resistance-associated macrophage protein 1, C4B and interleukin-6] have been found to be associated with one or more LR outcomes. The identification of host genetic markers with predictive value for LR would have a major impact on nerve damage control in leprosy. In this review, we present the recent advances achieved through genetic studies of LR.

Examining ERBB2 as a candidate gene for susceptibility to leprosy (Hansen’s disease) in Brazil

Leprosy remains prevalent in Brazil. ErbB2 is a receptor for leprosy bacilli entering Schwann cells, which mediates Mycobacterium leprae-induced demyelination and the ERBB2 gene lies within a leprosy susceptibility locus on chromosome 17q11-q21. To determine whether polymorphisms at the ERBB2 locus contribute to this linkage peak, three haplotype tagging single nucleotide polymorphisms (tag-SNPs) (rs2517956, rs2952156, rs1058808) were genotyped in 72 families (208 cases; 372 individuals) from the state of Pará (PA). All three tag-SNPs were associated with leprosy per se [best SNP rs2517959 odds ratio (OR) = 2.22; 95% confidence interval (CI) 1.37-3.59; p = 0.001]. Lepromatous (LL) (OR = 3.25; 95% CI 1.37-7.70; p = 0.007) and tuberculoid (TT) (OR = 1.79; 95% CI 1.04-3.05; p = 0.034) leprosy both contributed to the association, which is consistent with the previous linkage to chromosome 17q11-q21 in the population from PA and supports the functional role of ErbB2 in disease pathogenesis. To attempt to replicate these findings, six SNPs (rs2517955, rs2517956, rs1810132, rs2952156, rs1801200, rs1058808) were genotyped in a population-based sample of 570 leprosy cases and 370 controls from the state of Rio Grande do Norte (RN) and the results were analysed using logistic regression analysis. However, none of the associations were replicated in the RN sample, whether analysed for leprosy per se, LL leprosy, TT leprosy, erythema nodosum leprosum or reversal reaction conditions. The role of polymorphisms at ERBB2 in controlling susceptibility to leprosy in Brazil therefore remains unclear.