Pyogenic abscesses and parasitic diseases

Parasitic diseases which during their course in the host switch the immune system from a T helper 1 to a T helper 2 response may be detrimental to the host, contributing to granuloma formation, eosinophilia, hyper-IgE, and increased susceptibility to bacterial and fungal infections. Patients and animals with acute schistosomiasis and hyper-IgE in their serum develop pyogenic liver abscess in the presence of bacteremia caused by Staphylococcus aureus. The Salmonella-S. mansoni association has also been well documented. The association of tropical pyomyositis (pyogenic muscle abscess) and pyogenic liver abscess with Toxocara infection has recently been described in the same context. In tropical countries that may be an interesting explanation for the great morbidity of bacterial diseases. If the association of parasitic infections and pyogenic abscesses and/or fungal diseases are confirmed, there will be a strong case in favor of universal treatment for parasitic diseases to prevent or decrease the morbidity of superinfection with bacteria and fungi.

Fonsecaea pedrosoi cerebral phaeohyphomycosis ("chromoblastomycosis"): first human culture-proven case reported in Brazil

Cerebral phaeohyphomycosis ("chromoblastomycosis") is a rare intracranial lesion. We report the first human culture-proven case of brain abscesses due to Fonsecaea pedrosoi in Brazil. The patient, a 28 year-old immunocompetent white male, had ocular manifestations and a hypertensive intracranial syndrome. Magnetic resonance imaging (MRI) of the brain revealed a main tumoral mass involving the right temporo-occipital area and another smaller apparently healed lesion at the left occipital lobe. A cerebral biopsy was performed and the pathological report was cerebral chromoblastomycosis. The main lesion was enucleated surgically and culture of the necrotic and suppurative mass grew a fungus identified as Fonsecaea pedrosoi. The patient had received a knife wound sixteen years prior to his hospitalization and, more recently, manifested a pulmonary granulomatous lesion in the right lung with a single non-pigmented form of a fungus present. It was speculated that the fungus might have gained entrance to the host through the skin lesion, although a primary respiratory lesion was not excluded. The patient was discharged from the hospital still with ocular manifestations and on antimycotic therapy and was followed for eight months without disease recurrence. Few months after he had complications of the previous neuro-surgery and died. A complete autopsy was performed and no residual fungal disease was found.

Disfagia e Disartria. Forma Invulgar de Apresentação da Miastenia Gravis

Myasthenia Gravis is an autoimmune disorder that generally presents with ocular symptoms, specially diplopia and ptosis. Dysphagia may be a manifestation of the generalised type of the disease, but rarely is its presenting feature. The authors describe a case of Myasthenia Gravis in an old patient complaining of dysphagia and dysarthria. Because Myasthenia Gravis is a potentially serious but treatable disease, we emphasize the need to consider it in the differential diagnosis of dysphagia, namely in the elderly. In fact, the disorder is probably underdiagnosed in this population group, because clinicians tend to accept other more frequent diagnosis to explain these symptoms.

The frequency rate of Toxocara species contamination in soil samples from public yards in a urban area "Payathai", Bangkok, Thailand

Toxocara species are most common roundworms of Canidae and Felidae. Human toxocariasis develops by ingesting of embryonated eggs in contaminated soil. There is no previous report of Toxocara contamination in the soil samples from the public areas in Bangkok. For this reason our study have been carried out to examine the frequency of Toxocara eggs in public yards in Bangkok, Thailand. A total of 175 sand and clay samples were collected and examined for parasite eggs. According to this study, Toxocara eggs were detected from 10 (5.71%) of 175 soil samples. The high rate of contamination in this study implies the importance of the control of this possible zoonotic disease: control of abandon of dogs and cats, is still necessary.

Orbital tuberculosis diagnosed by immunohistochemistry: case reports

PURPOSE: To describe three cases of orbital tuberculosis, with their clinical characteristics and respective diagnostic procedures, showing the importance of histopathology for the correct diagnosis. PATIENTS AND METHODS: Three patients diagnosed and treated for orbital tuberculosis, in the "Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo" during the years of 1999 and 2001. RESULTS: All of the patients were female and referred a chronic evolution of swelling of one eyelid associated or not with other symptoms. They had not HIV infection. Two of them had positive epidemiology for tuberculosis. However, the search for systemic evidence of the disease and staining for bacilli (Ziehl-Neelsen method) were negative in all three patients. In all the cases, only the biopsy with immunohistochemical analysis could confirm the diagnosis. COMMENTS: Orbital involvement is a rare ocular manifestation of tuberculosis. Even in a tertiary hospital, few cases, if any, are diagnosed per year. However, the global incidence and prevalence of M. tuberculosis infections is not under control yet, and it has been a serious public health problem. Thus, one must be aware of the possibility of tuberculosis among the orbital diseases.

Monitorização da Adesão à Terapêutica Médica do Glaucoma

Introdução: A adesão à terapêutica antiglaucomatosa é fundamental na redução e controlo da pressão intra-ocular. O glaucoma, por ser uma doença crónica e inicialmente assintomática, tem um risco aumentado de não cumprimento terapêutico. Este estudo tem como objectivo a avaliação da adesão à terapêutica médica do glaucoma (estrita e relativa), através da utilização de um dispositivo de registo electrónico (DRE). Material e Métodos: Estudo prospectivo que incluiu 21 doentes, com glaucoma ou hipertensão ocular. Um e três meses após a visita inicial, procedeu-se ao preenchimento de um questionário relativo à compliance e analisaram-se os dados registados no DRE. Resultados: A idade média dos doentes era 62,4 anos (± 19,2), 52% do sexo masculino e 48% do sexo feminino. A compliance média relativa foi de 77,9% no primeiro mês e de 78,7% no final do terceiro mês. A compliance média estrita foi de 56,7% e de 53.3% no final do primeiro e terceiro mês, respectivamente. A maioria dos doentes sentiu facilidade (80,9%) e deseja continuar (85,7%) a utilização do mesmo. Conclusão: A adesão à terapêutica médica do glaucoma, factor importante no controlo desta patologia, pode ser avaliada de forma simples e objectiva através da utilização de um dispositivo de registo electrónico.

Análise da Repercussão de uma Sessão Educativa sobre o Glaucoma no Conhecimento da Doença

Introdução: A adesão à terapêutica antiglaucomatosa é fundamental na redução e controlo da pressão intra-ocular. Os doentes com menor nível de conhecimento sobre a sua doença apresentam taxas de não adesão terapêutica superiores. Este estudo tem como objectivo a avaliação da repercussão de uma sessão de esclarecimento sobre o glaucoma e seu tratamento. Material e métodos: Estudo prospectivo que incluiu 24 doentes seguidos em consulta de glaucoma. Procedeu-se ao preenchimento de um questionário validado, sobre a doença e o seu tratamento. De seguida os doentes assistiram a uma sessão de esclarecimento sobre o glaucoma. O preenchimento do questionário foi repetido após a sessão e ao fim de 1 mês. Resultados: A idade média foi 63,7 anos, 45,8% era do sexo feminino. Em 9 das 22 perguntas, mais de 50% dos doentes responderam acertadamente antes da sessão educativa. Após a realização da mesma foram 13 as respostas acertadas por mais de 50% dos doentes (p<0,001). Não foi encontrada relação entre o desempenho do questionário e a duração da doença (p>0,05) e o nível de escolaridade (p>0,05). Conclusão: Através da sessão educativa houve uma melhoria dos conhecimentos dos doentes com glaucoma, relativamente à sua doença.

Multifocalidade e Estereopsia

Introdução: A visão binocular proporciona uma interpretação única e tridimensional do mundo. Objectivo: Comparar a estereopsia dos doentes com de lentes intra-oculares (LIO) multifocais implantadas. Métodos: Os autores realizaram um estudo transversal com 40 doentes, que tinham sido submetidos a facoemulsificação com implante de LIO multifocal bilateralmente (26 Restor, 6 tecnis Multifocal e 8 "Mix & Match"). Estudaram a estereopsia de longe com o Vectograph e utilizaram o "Titmus Stereo Test" para perto, nos 3 grupos. Resultados: No grupo 1 (Restor bilateral: idade média 63,38 anos; 4 doentes do sexo masculino e 22 do feminino) obtivemos 80 a 90% de boa estereopsia; no grupo 2 (Tecnis Multifocal bilateral: idade média 73,67 anos; 6 doentes do sexo feminino) registou-se 100% de boa estereopsia e no grupo 3 ("Mix & Match": idade média 74,25 anos; 2 doentes do sexo masculino e 6 do feminino) obteve-se 50 a 75% de boa estereopsia. Conclusões: Os doentes com lentes intra-oculares multifocais similares implantadas bilateralmente obtiveram melhor estereopsia para perto e para longe.

Miosite Orbitária

Orbital myositis is a subgroup of the nonspecific inflammatory syndrome or orbital pseudotumor and is characterized by a primary inflammation of extraocular muscles. The authors describe a 70-year-old patient with acute proptosis, ocular pain and right ophthalmoplegia, whose orbital computed tomographic scan showed enlargement of the homolateral extraocular muscles. Clinical presentation and complementary tests were compatible with the diagnosis of orbital myositis however, because of the particular aspects, which included retinal central vein occlusion, optic nerve lesion, distension of the superior ophthalmic vein and the homolateral cavernous sinus, the differential diagnosis with cavernous sinus pathology and thyroid ophthalmopathy was considered. The importance of a rapid diagnosis and treatment is stressed.

Environmental contamination by Toxocara sp. eggs in Ribeirão Preto, São Paulo State, Brazil

Toxocariasis is a zoonosis mainly caused by Toxocara canis, an intestinal nematode of dogs. Man acquires the infection through accidental ingestion of viable eggs, and the toxocariasis clinical manifestations may vary from an asymptomatic infection up to the Visceral Larva Migrans syndrome. Seventy eight public squares of Ribeirão Preto, São Paulo, Brazil, including Bonfim Paulista district were visited aiming to evaluate the soil contamination by Toxocara eggs. The squares were divided in five different areas corresponding to the Sanitary Districts of the city. From May to December 2003, soil samples weighting about 250 g each were collected from five distinct sites of each public square. The laboratorial analysis was done by centrifugal-flotation techniques in magnesium sulphate solutions with 5% of potassium iodide (d = 1.33) and zinc sulphate (d = 1.20), and by the sedimentation- flotation in conic chalices with zinc sulphate (d = 1.20). Toxocara sp. eggs were found on 16 (20.5%) squares, with the lowest prevalence (12%) at the central area. From these results, it is expected that the legal authority will adopt protection measures for the city public areas, reducing thus the contamination risk by Toxocara sp. eggs.

Doença de Behçet. Experiência de um Serviço de Medicina Interna

Os autores apresentam um estudo retrospectivo dos doentes com Doença de Behçet observados num Serviço de Medicina Interna entre 1982 e 2000. Foram analisados 33 doentes, sendo 20 do sexo masculino e 13 do sexo feminino. A primeira manifestação surgiu, em média, aos 24 anos e a média de idades, na altura do diagnóstico, foi de 32 anos. Todos os doentes apresentaram na sua evolução aftose oral recorrente, surgindo aftose genital em 84,8%, patologia ocular em 81,8%, articular em 75,7%, cutânea em 69,6%, alterações do sistema nervoso central em 27,3%, gerais em 24,2%, vasculares em 21,2%, gastrintestinais em 18,1%, neuropatia periférica em 12,1% e vasculite em 3% dos doentes observados.

Sarcoma de Kaposi da Conjuntiva. Apresentação Invulgar de SIDA

O sarcoma de Kaposi ocular isolado surge em 0,3% a 5% dos doentes com SIDA, mas, em doentes com tumor disseminado, esta incidência aumenta para 15% a 20%. Apresentamos um caso de sarcoma de Kaposi epidémico, mucocutâneo, cuja primeira manifestação foi ocular. O tratamento inicial consistiu na administração quinzenal de daunorrubicina lipossómica e de anti-retrovíricos. Sob terapêutica houve progressão da doença, tendo sido a sua regressão conseguida, apenas, com um esquema alternativo de quimioterapia associada a cidofovir. Aproveitamos para rever esta entidade, em particular as formas oculares, e discutir a utilização de cidofovir no tratamento do sarcoma de Kaposi associado ao vírus herpes humano tipo 8.

Are coffee silverskin extracts safe for topical use? An in vitro and in vivo approach

Recent changes in regulatory requirements and social views on animal testing have incremented the development of reliable alternative tests for predicting skin and ocular irritation potential of products based on new raw materials. In this regard, botanical ingredients used in cosmetic products are among those materials, and should be carefully reviewed concerning the potential presence of irritant constituents. In particular, cosmetic products used on the face, in vicinity of the eyes or that may come in contact with mucous membranes, should avoid botanical ingredients that contain, or are suspected to contain, such ingredients. In this study, we aimed to evaluate the effect of a new cosmetic ingredient, namely, coffee silverskin (CS), with an in vitro skin and ocular irritation assay using reconstructed human epidermis, EpiSkin™, and human corneal epithelial model, SkinEthics™ HCE, and an in vivo assay. Three different extracts of CS were evaluated. The histology of the models after extracts applications was analysed. The in vitro results demonstrated that extracts were not classified as irritant and the histological analyses proved that extracts did not affect both models structure. The content of caffeine, 5-hydroxymethyl furfural and chlorogenic acid was quantified after the epidermal assay. The in vivo test carried out with the most promising extract (hydroalcoholic) showed that, with respect to irritant effects, these extracts can be regarded as safe for topical application.

Frequency of toxocara infection in children attended by the health public service of Maringá, south Brazil

The lack of specific laboratorial diagnosis methods and precise symptoms makes the toxocariasis a neglected disease in Public Health Services. This study aims to determine the frequency of Toxocara spp. infection in children attended by the Health Public Service of Hospital Municipal de Maringá, South Brazil. To evaluate the association of epidemiological and clinical data, an observational and cross-section study was carried out. From 14,690 attended children/year aged from seven month to 12 years old, 450 serum samples were randomly collected from September/2004 to September/2005. A questionnaire was used to evaluate epidemiological, clinical and hematological data. An ELISA using Toxocara canis larval excretory-secretory products as antigen detected 130 (28.8%) positive sera, mainly between children from seven month to five years old (p = 0.0016). Significant correlation was observed between positive serology for Toxocara, and frequent playing in sandbox at school or daycare center (p = 0.011) and the presence of a cat at home (p = 0.056). From the families, 50% were dog owners which exposed soil backyards. Eosinophilia (p = 0.776), and signs and symptoms analyzed (fever p = 0.992, pneumonia p = 0.289, cold-like symptoms p = 0.277, cough p = 0.783, gastrointestinal problems p = 0.877, migraine p = 0.979, abdominal pain p = 0.965, joint pain p = 0.686 and skin rash p = 0.105) could not be related to the presence of anti-Toxocara antibodies. Therefore, two asthmatics children showed titles of 1:10,240 and accentuated eosinophilia (p = 0.0001). The authors emphasize the needs of prevention activities.

Intraocular Pressure Correlates with Optic Nerve Sheath Diameter in Patients with Normal Tension Glaucoma

PURPOSE: 1. Identify differences in optic nerve sheath diameter (ONSD) as an indirect measure of intracranial pressure (ICP) in glaucoma patients and a healthy population. 2. Identify variables that may correlate with ONSD in primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG) patients. METHODS: Patients with NTG (n = 46) and POAG (n = 61), and healthy controls (n = 42) underwent B-scan ultrasound measurement of ONSD by an observer masked to the patient diagnosis. Intraocular pressure (IOP) was measured in all groups, with additional central corneal thickness (CCT) and visual field defect measurements in glaucomatous patients. Only one eye per patient was selected. Kruskal-Wallis or Mann-Whitney were used to compare the different variables between the diagnostic groups. Spearman correlations were used to explore relationships among these variables. RESULTS: ONSD was not significantly different between healthy, NTG and POAG patients (6.09 ± 0.78, 6.03 ± 0.69, and 5.71 ± 0.83 respectively; p = 0.08). Visual field damage and CCT were not correlated with ONSD in either of the glaucoma groups (POAG, p = 0.31 and 0.44; NTG, p = 0.48 and 0.90 respectively). However, ONSD did correlate with IOP in NTG patients (r = 0.53, p < 0.001), while it did not in POAG patients and healthy controls (p = 0.86, p = 0.46 respectively). Patient's age did not relate to ONSD in any of the groups (p > 0.25 in all groups). CONCLUSIONS: Indirect measurements of ICP by ultrasound assessment of the ONSD may provide further insights into the retrolaminar pressure component in glaucoma. The correlation of ONSD with IOP solely in NTG patients suggests that the translaminar pressure gradient may be of particular importance in this type of glaucoma.