Paracoccidioidomycosis in a Dog: Case Report of Generalized Lymphadenomegaly

Paracoccidioidomycosis (PCM) is a severe systemic mycosis, endemic in Latin America and highly prevalent in Brazil, where it ranks eighth as a mortality cause among infectious and parasitic diseases in humans. The disease in animals has been little explored. It is observed that armadillos can harbor the fungus at high frequencies, although the active disease has not been well documented in this wild mammal. Dogs are susceptible to experimental infection, and the naturally acquired PCM-disease was reported only recently in a dog from Brazil. The present work reports the second case of naturally acquired PCM in a 6-year-old female dog that presented emaciation, lymphadenomegaly, and hepatosplenomegaly. Biochemical and pulmonary radiographic evaluation did not reveal any abnormalities. PCM was diagnosed by clinical findings, culturing, immunohistochemistry, and histopathology of popliteal lymph node. The fungus was recovered from popliteal lymph node, and the molecular analysis showed respective sequencing similarities of 99 and 100% for 803 nucleotides of the Gp43 gene and 592 nucleotides from the ITS-5.8S region of Paracoccidioides brasiliensis. Immunohistochemistry revealed severe lymphadenitis and presented numerous yeasts, which reacted against the gp43 antibody. Histopathology revealed a severe granulomatous lymphadenitis associated with numerous single or multiple budding yeasts. After diagnosis, the dog was successfully treated with itraconazol for 2 years. Veterinarians should be aware of the importance of considering PCM for differential diagnosis, especially in dogs from PCM-endemic areas, whose monophagocytic system involvement is evident.

Oro-genital lichen planus: Report of two cases

Lichen planus is a common mucocutaneous disease. However, lichen planus with concomitant oral and genital involvement is a rare condition that requires multidisciplinary intervention for appropriate diagnosis. In this study, we reported two cases of oro-genital lichen planus in a man and a woman. Analyses of oral and genital lesions were clinically and histopathologically compatible with lichen planus. This description highlights the importance of patients presenting oral lichen planus be routinely required to undergo further medical examination in order to investigate putative genital mucosal involvement. These lesions have the potential to progress to neoplasia. Therefore, medical and dentistry professionals should be aware of this condition. (c) 2007 Elsevier B.V. All fights reserved.

Tegu (teiu) bite: Report of human injury caused by a Teiidae lizard

Lizards of the Teiidae family are large reptiles measuring up to 2 meters long. If threatened, they can demonstrate aggressive behavior by whipping their tail and occasionally biting. Here, we report a severe injury following a Teiidae lizard bite on the right index finger of a human. There was significant soft tissue damage and an avulsion fracture of the distal phalanx. He was treated with conservative wound care and prophylactic antibiotics. He developed no evidence of secondary infection and underwent delayed skin grafting.

Paracoccidioidomycosis of external genitalia: report of six new cases and review of the literature

BACKGROUND: Paracoccidioidomycosis is a systemic mycosis of dermatological interest due to the frequency of cutaneous and mucosal lesions. The involvement of the external genitalia is extremely rare and few cases have been reported.OBJECTIVE: To study the prevalence of external genitalia lesions in paracoccidioidomycosis patients, identify clinical characteristics and compare with what is observed in the specific literature.METHODS: This is a cross-sectional, descriptive study, with focus on paracoccidioiodomycosis patients with external genitalia lesions. The demographic and clinical aspects of cases were compared with what has been reported so far on LILACS, SciELO e MEDLINE data bases.RESULTS: Data of 483 cases of paracoccidioidomycosis were studied in a 42-year period. Six (1.2%) patients showed specific lesions on external genitalia. Five patients were male with mean age of 47.2 years and all of them presented with the chronic multifocal clinical form. Only one, a 15-year-old female patient was observed who showed a subacute clinical form, juvenile type.CONCLUSIONS: Compromise of the genitourinary tract among paracoccidioidomycosis patients is rare and even rarer when only the external genitalia are considered. As observed in the classical picture of paracoccidioidomycosis patients, the male gender and the chronic multifocal clinical form prevailed in the present study.

Report of a human accident caused by Conus regius (Gastropoda, Conidae)

Conus regius is a venomous mollusc in the Conidae family, which includes species responsible for severe or even fatal accidents affecting human beings. This is the first report on a clinical case involving this species. It consisted a puncture in the right hand of a diver who presented paresthesia and movement difficulty in the whole limb. The manifestations disappeared after around twelve hours, without sequelae.

Seabather's eruption: report of five cases in southeast region of Brazil

Os autores relatam cinco acidentes de seabather's eruption ou prurido do traje de banho, uma erupção típica associada na maioria das vezes à água-viva Linuche unguiculata (Cnidaria), que causa um rash pápulo-eritematoso extremamente pruriginoso em áreas cobertas por trajes de banho. O quadro cutâneo é característico e a erupção é comum no Caribe, Flórida, México e estados americanos do Golfo. Os casos são os primeiros relatados no Brasil e larvas de Linuche unguiculata estão presentes nas águas onde ocorreram os acidentes.

Family visitors and companions of hospitalized elderly and adults: analysis of the experience from the perspective of the nursing working process

Trata-se de estudo qualitativo, utilizando-se como referencial metodológico a Grounded Theory e como referencial teórico o Processo de Trabalho em Enfermagem, para compreender o papel assumido pelo enfermeiro perante as normas e rotinas hospitalares, relativas aos familiares visitantes e acompanhantes de adultos e idosos internados em um Hospital Universitário. A análise dos dados permitiu a identificação do tema: definindo-se a modalidade de apoio familiar durante a hospitalização, que reúne duas categorias principais: tornando-se familiar visitante e tornando-se familiar acompanhante. Por meio da análise, pôde-se aprofundar a compreensão do quanto as regras estabelecidas, com o objetivo de disciplinar e tornar eficiente o trabalho desenvolvido no hospital, podem explicitar o desprovimento de autonomia no processo de trabalho, para modificar as relações nesse contexto e o quanto a apropriação do familiar como parte da equipe de saúde, está distante de ser pensada no concreto das instituições.

Primary Pulmonary Choriocarcinoma After Human Chorionic Gonadotropin Normalization Following Hydatidiform Mole A Report of Two Cases

BACKGROUND: Primary pulmonary choriocarcinoma (PPC) is rare and frequently leads to death.CASES: Two young patients presented with previous molar pregnancy and spontaneous serum human chorionic gonadotropin (hCG) normalization. Patient 1 was referred to our center after partial response to chemotherapy. Pulmonary lobectomy was performed, and hCG rapidly declined. During further chemotherapy, liver metastasis was detected by positron emission tomography. Right hepatectomy was performed, and hCG declined for 28 days, but increased again despite chemotherapy. This patient died from hepatic failure 3 years after diagnosis. Patient 2 presented with persistently high hCG, though the affected organ was not identified. Chemotherapy was unsuccessful. Patient reevaluation showed an isolated pulmonary mass. Pulmonary lobectomy was performed; 2 weeks later, hCG was normal and consolidation with 2 cycles of chemotherapy was administered. The patient has been in remission for 24 months. PPC was confirmed by histo pathology and immunohistochemistry in both cases. Gestational origin of the tumor was confirmed by molecular genetic analysis (polymorphic microsatellite markers).CONCLUSION: The possibility of choriocarcinoma cannot be overlooked in young women with an isolated pulmonary mass. Early diagnosis, prompt chemotherapy, and surgical resection in a specialized center improves the prognosis. (J Reprod Med 2010;55:311-316)

Abdominopelvic sarcoma of perivascular epithelioid cells. Report of four cases in young women, one with tuberous sclerosis

The perivascular epithelioid cell has been proposed to be the unifying proliferating cell type in a number of lesions such as angiomyolipoma, lymphangiomyomatosis, clear cell sugar tumor and renal capsuloma. With the exception of rare examples of angiomyolipoma, they are non-metastasizing. We report four examples of a new member of this family of perivascular epithelioid cell neoplasms that occur in abdominopelvic location and show metastatic properties. The patients, all women, were aged 19 to 41 years (mean, 32), and presented with a tumor mass involving the serosa of the ileum, uterus or pelvic cavity. Morphologically, the tumors were composed of sheets of large polygonal cells with glycogen-rich clear or eosinophilic cytoplasm and moderately pleomorphic nuclei, traversed by a delicate vasculature, mimicking clear cell carcinoma. There were areas of coagulative necrosis and occasional mitotic figures. Intracytoplasmic brown pigment was present in two cases. Spindly cells, smooth muscle and fat were absent. Lymphovascular invasion was present in all, lymph node metastasis was documented in two and metastasis to the ovary was present in one case. Two patients developed widespread metastatic disease after 10 and 28 months from diagnosis. One patient showed the clinical signs of tuberous sclerosis. In spite of the epithelial-like appearance, the tumor cells were negative for epithelial markers but were strongly positive with the melanogenesis-related marker HMB45. Another melanogenesis marker (MART-1) was positive in two cases. Other markers including S-100 protein, vimentin, muscle-specific actin, desmin and chromogranin A were negative. Thus, these tumors are not readily classifiable in the existing schema of known entities, and show over-lapping morpho-phenotypic features of clear cell sugar tumor of the lung and epithelioid angiomyolipoma. We consider them as sarcomas composed of a pure population of uncommitted perivascular epithelioid cell, that lack modulation toward smooth muscle or adipose cells.

Fine needle aspiration (FNA) cytology of pilomatrixoma: report of 14 cases and review of the literature

We describe 14 cases of pilomatrixoma which were diagnosed preoperatively on FNA cytology. In contrast to the literature, our series showed male preponderance and some of the tumours in unusual locations such as thigh and breast. In three patients the rumours were larger than 5 cm. The clinical diagnosis varied from tumour not otherwise defined to sarcoma. The cytologic presentation had features which allowed a correct diagnosis in all cases and included basaloid cells surrounded by delicate pink fibres, shadow cells, giant cells, naked nuclei and calcium deposits. It is concluded that the FNA cytology of pilomatrixoma is characteristic and will allow a conclusive diagnosis even in cases with an aberrant clinical presentation.

Granulocytic sarcoma of the small intestine with CBF beta/MYH11 fusion gene: report of an aleukaemic case and review of the literature

Granulocytic sarcomas (GS) are rare extramedullary tumours composed of immature myeloid cells. Inversion of chromosome 16 [inv(16)] is a cytogenetic marker for M4Eo subtype of acute myeloid leukaemia (AML). The possibility of an association between the development of granulocytic sarcoma of the small intestine (GSSI) and the M4Eo subtype of AML was suggested in nine previous case reports.Here we report an aleukaemic case of GSSI with inv(16) and its molecular equivalent, the CBFbeta/MYH11 fusion gene, detected by reverse transcriptase-polymerase chain reaction (RT-PCR), that after treatment with conventional AML chemotherapy followed by autologous bone marrow transplantation, achieved complete haematological and molecular remission on bone marrow examination. After chemotherapy, a thickened ileum wall positive for CBFbeta/MYH11 on tumour mass samples was still observed on computed tomography (CT) studies, raising the question of residual GS representing a reservoir of malignant cells. This case demonstrates the critical need of multidisciplinary diagnosis and follow-up of this entity combining immunopathologic, cytogenetic and molecular studies, reinforcing the potentiality of risk-adapted therapy strategies, as it is increasingly claimed for patients with overt AML. (C) 2003 Elsevier Ltd. All rights reserved.

Early administration of inhaled nitric oxide to children with acute respiratory distress syndrome and its effects on oxygenation and ventilator settings: prospective preliminary report of ten patients

Aim. To establish a protocol for the early introduction of inhaled nitric oxide (iNO) therapy in children with acute respiratory distress syndrome (ARDS) and to assess its acute and sustained effects on oxygenation and ventilator settings.Patients and Methods. Ten children with ARDS, aged 1 to 132 months (median, 11 months), with arterial saturation of oxygen <88% while receiving a fraction of inspired oxygen (FiO(2)) 0.6 and a positive end-expiratory pressure of greater than or equal to 10 cm H2O were included in the study. The acute response to iNO was assessed in a 4-hour dose-response test, and positive response was defined as an increase in the PaO2/FiO(2) ratio of 10 mmHg above baseline values. Conventional therapy was not changed during the test. In the following days, patients who had shown positive response continued to receive the lowest iNO dose. Hemodynamics, PaO2/FiO(2), oxygenation index, gas exchange, and methemoglobin levels were obtained when needed. Inhaled nitric oxide withdrawal followed predetermined rules.Results. At the end of the 4-hour test, all the children showed significant improvement in the PaO2/FiO(2) ratio (63.6%) and the oxygenation index (44.9%) compared with the baseline values. Prolonged treatment was associated with improvement in oxygenation, so that FiO(2) and peak inspiratory pressure could be quickly and significantly reduced., No toxicity from methemoglobin or nitrogen dioxide was observed.Conclusion. Administration of iNO to children is safe. iNO causes rapid and sustained improvement in oxygenation without adverse effects. Ventilator settings can safely be reduced during iNO treatment.

Nocardiosis: an overview and additional report of 28 cases in cattle and dogs

A caracterização fenotípica, perfil de sensibilidade aos antimicrobianos e aspectos clínico-epidemiológicos foram avaliados em 28 linhagens de Nocardia isoladas de 19 casos de mastite, oito lesões tegumentares e um caso de pneumonia em cão. Foram utilizados no diagnóstico métodos microbiológicos, bioquímicos, citológicos e microscopia eletrônica de varredura. Nocardia asteroides tipo IV, N. otitidiscaviarum,N. nova (tipo III) e N. farcinica (tipo V) foram isoladas do leite de vacas com mastite, de material de lavado transtraqueal e de lesões cutâneas de cães. Nocardiose mamária bovina foi diagnosticada predominantemente sob a forma clínica, em propriedades com precárias condições de higiene na pré e pós-ordenha, e inadequado procedimento de terapia intramamária. Nocardiose canina foi diagnosticada comumente em animais co-infectados com o vírus da cinomose. Sulfametoxazole/trimetoprim (92,8%), amicacina (92,8%) e ceftiofur (92,8%) foram os antimicrobianos mais efetivos frente às linhagens de Nocardia. Resistência múltipla a três ou mais e cinco ou mais antimicrobianos foram observadas, respectivamente, em dez (35,7%) e três (10,7%) linhagens, notadamente frente à cloxacilina, cefoperazona e ampicilina. A caracterização de espécies (tipo), aspectos clínico-epidemiológicos, diagnóstico, resistência múltipla aos antimicrobianos e reflexos em saúde pública de linhagens de Nocardia isoladas de bovinos e cães no Brasil foram discutidos. Foi destacada a similaridade entre as espécies de Nocardia isoladas de animais e do homem, e a primeira descrição no Brasil de N. otitidiscaviarum na etiologia da mastite bovina.

First report of coenurosis in sheep in the State of Mato Grosso do Sul, Brazil

Este trabalho relata o primeiro caso de cenurose no Estado de Mato Grosso do Sul, Brasil. Essa doença é causada por estágios larvais de Taenia multiceps (Leske, 1780). O animal no qual foi diagnosticado, tinha cerca de 18 meses de idade, oriundo de uma área endêmica no Sul do Brasil, integrante de um grupo de 30 ovinos importados para o Estado de Mato Grosso do Sul. O quadro clínico-patológico apresentado é aquele comumente descrito para herbívoros, infectados com o agente, especialmente ovinos. Os sinais clínicos relatados foram: apatia, nistagmo, cegueira intermitente, andar em círculos e pressão da cabeça contra obstáculos. Na necropsia foi observada uma lesão, no subcórtex do hemisfério cerebral direito, caracterizada por um cisto em forma de vesícula, medindo 4 cm de diâmetro, e seu interior preenchido por líquido translúcido com grande número de pequenas esferas brancas, identificadas como protoscolices. Os protoscolices foram identificados como Coenurus cerebralis, e os tecidos do cérebro submetidos complementarmente a exames histopatológicos para descrição da lesão.