Tropical dermatology: Venomous arthropods and human skin Part II. Diplopoda, Chilopoda, and Arachnida

Members of arthropod classes Chilopoda (centipedes), Diplopoda (millipedes), and Arachnida (spiders and scorpions) cause tissue injury via bites, stings, and/or a release of toxins. A few members of the Acari subclass of Arachnida (mites and ticks) can transmit a variety of infectious diseases, but this review will cover the noninfectious manifestations of these vectors. Dermatologists should be familiar with the injuries caused by these arthropods in order to initiate proper treatment and recommend effective preventative measures. (J Am Acad Dermatol 2012;67:347.e1-9.)

Experimental infection with Leishmania chagasi in immunosuppressed Balb/c mice: cytokines and parasite burdens

The immune response in leishmaniasis may result in a polarization of the T lymphocyte subpopulation, altering cell phenotype and resulting in immune protection or disease exacerbation. Leishmania may persist in the body either during asymptomatic infections or after treatment, which represents high risk under immunosuppression. The objective of this study was to evaluate the effect of infection with immunosuppression by dexamethasone associated with pentoxifylline on animal weight, spleen weight, spleen and hepatic parasitic load and immunopathology, as well as the IFN-gamma and IL-10 production in spleen cell culture of Balb/c mice infected with Leishmania chagasi. The infection did not cause body weight gain in animals, but both the weight and size of the spleen were increased. The immunosuppression using dexamethasone associated with pentoxifylline affected body weight gain and spleen weight and size in both infected and non-infected animals. The immunosuppression did not significantly alter the course of the splenic or hepatic parasite burden. Dexamethasone and pentoxifylline significantly affected cytokine production, but did not influence the Th1/Th2 ratio in infected animals.

Experimental infection of Leishmania chagasi in immunosuppressed balb/c mice: cellular immune response and parasite burden

The immune response to leishmaniasis can result in a polarization of a subpopulation of T lymphocytes, which leads to a different cell phenotype and results in immune protection or exacerbation of the disease. Leishmanias persist in the body both in asymptomatic infections and after treatment, representing risks in terms of immunosuppression. The objective of this study was to evaluate the effects of infection and immunosuppression by dexamethasone associated with pentoxifylline on animal weight, spleen weight, the parasitic load in the spleen and liver, as well as the production of IFN-gamma and IL-10 in spleen cell culture of Balb/c mice infected with Leishmania chagasi. The infection did not alter animal weight gain, but spleen weight and size increased. The immunosuppression, induced by dexamethasone associated with pentoxifylline, affected animal weight gain and weight and size of the spleen (in infected and not infected animals). The immunosuppression did not significantly alter the course of the parasite burden in the spleen and liver. Dexamethasone and pentoxifylline affected the studied cytokine production, but not influenced on Th1/Th2 response in infected animals.

Definition of a diagnostic routine in individuals with inconclusive serology for chagas disease

Despite the existence of highly sensitive tests, inconclusive serological results are frequent in chronic chagasic infection. This study aimed to define a diagnostic conduct for 30 individuals with inconclusive serology (G3) for chagasic infection assisted at the Outpatient Unit for Infectious and Parasitic Diseases of the Botucatu School of Medicine. Twenty-one individuals with negative serology (G1) and 33 with positive serology (G2) were also studied. Serological methods ELISA, HAI, IFI and immunoblotting TESA-cruzi were used for G1, G2 and G3, and parasitological methods xenodiagnosis, hemoculture and PCR-LIT were used for G2 and G3 individuals. ELISA, HAI and IFI were performed in 5 different blood samples in G2 and G3. TESA-cruzi was carried out only once in G1, G2 and G3 and, since it is the most sensitive, it was utilized as standard. In G3, positivity for ELISA reached 86% in the fifth blood sample; the ELISA+HAI+IFI combination showed a maximum of 44.8% in the second sample; and TESA-cruzi, 76% in one single sample. Xenodiagnosis positivity was 9.4%; hemoculture showed 15.2%; and PCR-LIT exhibited 22% positivity in G2. Nevertheless, in G3, positivity percentage was 3.4% for xenodiagnosis, 6.7% for PCR-LIT, and no positive result was found for hemoculture. In G3, PCR-LIT resolved one case which was still inconclusive according to serology tests. In order to define inconclusive diagnoses, the results suggest the combined use of ELISA+HAI+IFI in 2 blood samples, decreasing the occurrence of false positive/negative results. If results remain inconclusive, the performance of TESA-cruzi and PCR-LIT, if necessary, is recommended.

Edema cerebral crônico na neurocisticercose

Neste estudo retrospectivo, relatam-se as características clínicas do edema cerebral crônico (ECCr) em 34 pacientes com neurocisticercose (NCC), que apresentavam edema cerebral difuso, à tomografia computadorizada (TC), como característica comum. Todos foram tratados com dextroclorofeniramina e, 32 deles, com albendazol. O ECCr predominou no sexo feminino (73,5%) na faixa etária dos 11 - 40 anos (92,3%). A cefaléia ocorreu em 94,1% dos pacientes, náuseas/vômitos em 47,1%, crises epilépticas em 41,1% e distúrbios psíquicos em 38,2%. A hiperreflexia ocorreu em 82,3% e o papiledema em 58,8% e o exame neurológico normal em 11,8%. Na TC, o edema esteve associado a calcificações em 61,8% dos casos. As pressões liquóricas foram mais elevadas (p< 0,05) antes do tratamento. Atualmente, estão assintomáticos, ou com melhora clínica, 79,4% dos pacientes (57,1% deles sem medicação). Discute-se a possibilidade do ECCr, na NCC, ser uma manifestação antigênica, sem a presença concomitante de cistos parasitários, e poder representar mais uma condição clínica associada à hipertensão intracraniana benigna.

Lesões sequelares na laringe em pacientes com paracoccidiodomicose

A Paracoccidioidomicose (PCM) é uma doença sistêmica que em sua forma sequelar se caracteriza por manifestações clínicas relacionadas às alterações anatômicas ou funcionais de órgãos e sistemas comprometidos no período de estado. OBJETIVO: Descrever as alterações anatômicas e funcionais laríngeas sequelares em pacientes com paracoccidioidomicose. MATERIAL E MÉTODOS: Estudo retrospectivo, sendo avaliados 49 pacientes do sexo masculino, na faixa etária de 30 a 60 anos, entre 1999 a 2004, com diagnóstico de PCM em acompanhamento pela disciplina de Moléstias Infecciosas e Parasitárias, confirmado pela demonstração do fungo em escarro, exame citológico ou histopatológico. RESULTADOS: As pregas vocais foram a estrutura laríngea mais afetada, em 67% dos pacientes verificaram-se alterações. A epiglote estava acometida em 55% dos casos. As pregas ariepiglóticas tinham modificações em 53% dos pacientes. As pregas vestibulares estavam alteradas em 46% dos casos. em 40% dos casos verificaram-se alterações em aritenoides. Na fonação, 28% tinham limitação ao movimento das cordas vocais, paresia unilateral ocorreu em 4% casos. em 24% havia restrição da luz supraglótica e 4% tinham estenose glótica, sendo que 2% precisaram de traqueotomia. CONCLUSÃO: As lesões sequelares na laringe devido à infecção pelo P. brasilienses são extensas e causam restrições funcionais na maioria dos casos.

Appendiceal taeniasis presenting like acute appendicitis

A case of parasitic appendicitis caused by Taenia sp. in a 28-year-old woman from Brazil is reported. Histopathological data and a description of the helminthe found in the appendix lumen are presented.

Detection of IgG in cerebrospinal fluid for diagnosis of neurocysticercosis: evaluation of saline and SDS extracts from Taenia solium and Taenia crassiceps metacestodes by ELISA and immunoblot assay

We compared saline (S) and sodium dodecyl sulphate (SDS) extracts from Taenia solium (homologous species - HO) and Taenia crassiceps (heterologous species - HE) metacestodes in order to detect Ige by ELISA and immunoblot assay (IBA) in cerebrospinal fluid (CSF) for the diagnosis of human neurocysticercosis (NC). CSF samples were obtained from 93 patients. of these, 40 had NC, five had a diagnosis of probable NC, nine had central nervous system schistosomiasis or strongyloidiasis and 39 had other neurological alterations. Samples were analysed by ELISA and the results were compared with IBA in all samples with confirmed and probable NC diagnosis, in all samples with other central nervous system parasitic infection, and in 10 of those with another neurological alterations. ELISA sensitivity was 100%, 85%, 95% and 87.5% for the S-HO, S-HE, SDS-HO and SDS-HE extracts, respectively, and ELISA specificity was 100% for S-HO, S-HE, SDS-HO extracts and 97.9% for SDS-HE antigen. Immunodominant peptides detected by IBA were, by decreasing percentage of recognition: 64-68 and 45 kDa for S-HO; 108-114, 92-95, 64-68, 83 and 88 kDa for S-HE; 64-68, 108-114, 77 and 86 kDa for SDS-HO; and 108-114, 88 and 92-95 kDa for SDS-HE. Overall the homologous antigenic extracts showed higher sensitivity than the heterologous extracts in the diagnosis of NC in CSF samples. The heterologous extracts contained most of the immunodominant peptides presented in the homologous extracts, which are recognized by Ige antibodies in CSF samples.

Ocorrência de anticorpos anti-Neospora caninum em cães da microrregião da Serra de Botucatu, Estado de São Paulo, Brasil

Neosporose é uma enfermidade parasitária causada pelo protozoário Neospora caninum reconhecido como importante causa de abortamento bovino e neuropatia canina. Considerando o isolamento de N. caninum e a sorologia freqüente em bovinos em nossa região, os objetivos do presente trabalho foram avaliar a ocorrência de anticorpos anti-N. caninum em cães da Microrregião da Serra de Botucatu, Estado de SãoPaulo, e sua associação ao sexo, idade e procedência quanto à zona urbana (exclusivamente cidade), rural (somente chácaras e sítios) e peri-urbana (acesso à zona urbana e rural) dos cães estudados. Foram analisados 963 cães, com ou sem raça definida, de ambos os sexos e diferentes idades, sem apresentação de qualquer sintomatologia clínica. Os animais foram selecionados aleatoriamente durante a campanha de vacinação anti-rábica da microrregião da Serra de Botucatu, no período de maio a setembro de 1998. O soro obtido dos animais foi avaliado por meio da Reação de Imunofluorescência Indireta (RIFI) utilizando como antígeno a cepa padrão NC-1 deN. caninum. Observaram-se 245 animais reagentes (25,4% de positividade), sendo 161 (27,5%) machos e, 84 (22,3%) fêmeas. Dos animais de zona urbana, rural e mista 223 (25,8%),11(16,9%) e 11(33,3%), respectivamente, foram reagentes à prova de RIFI. Todos os 11 municípios apresentaram cães soropositivos com valores de ocorrência que variaram de 8,9% a 53,5%. Observou-se percentual de positividade menor em cães até um ano (16,2%) quando comparados àqueles entre 1 a 4 anos e superior a 4 anos (28,4 % e 28,0%, respectivamente) que não apresentaram diferença entre si. Os resultados obtidos caracterizaram soropositividade para N. caninum em cães pertencentes a todos os municípios da Microrregião da Serra de Botucatu evidenciando a ampla distribuição do agente na região.

Impact of leishmaniasis on public health

Leishmaniasis is a parasitic zoonosis caused by protozoans of the genus Leishmania transmitted by insects known as phlebotomines, which are found in wild or urban environments. It affects domestic and wild animals and transmission to man happens by accident. The disease occurs in tropical and sub-tropical areas, mainly in Asia, Europe, Africa, and the Americas. There are two forms that affect man: American cutaneous leishmaniasis (ACL) and American visceral leishmaniasis (AVL). The latter is caused by three species of Leishmania: Leishmania (Leishmania) donovani, Leishmania (Leishmania) infantum, and Leishmania (Leishmania) chagasi, which are grouped in the Leishmania (Leishmania) donovani complex. Wild reservoir hosts of L. chagasi known so far are foxes and marsupials. In domestic environment, dogs are the most important reservoir hosts and sources of infection to the vectors Lutzomyia longipalpis. Leishmaniasis is difficult to control, causing epidemic outbreaks, thus being an important public health problem. Due to lesions caused by the mucocutaneous type and the severity of those caused by the visceral type in humans, visceral leishmaniasis is one of the main public health concerns. This paper is part of the monograph presented at the end of the residency program in the field of Zoonosis and Public Health at the School of Veterinary Sciences and Animal Husbandry, São Paulo State University, UNESP, Botucatu, São Paulo State, Brazil, in 2005.

First Autochthonous Case of Canine Visceral Leishmaniasis in the Center of Rio Grande do Sul State, Brazil

Background: Leishmaniasis is one of the most important vector-borne diseases of humans. This parasitic disease can be caused by many species of Leishmania. In humans, different species of the parasite are associated with different forms of the disease, cutaneous and visceral. Among domesticated animals, dogs are the most important species in the epidemiology of this disease. Leishmania chagasi, an important zoonosis, is well established as the agent of visceral leishmaniasis in Brazil. The disease is endemic in north, northeast, midwest and southeast, and is transmitted to mammals by hematophagous insects such as the Lutzomyia longipalpis. In 2008, our research group has diagnosed a case of canine leishmaniasis in the municipality of Uruguaiana and subsequently there were several cases in the city and the neighbor municipality of Sao Borja. Most Brazilian states are endemic for leishmaniasis, with the exception of Rio Grande do Sul. In southern Brazil, the reports of humans and dogs infected by Leishmania spp. are the source of endemic area in the country. Therefore, the aim of this study is register the first clinical case of canine visceral leishmaniasis in the municipality of Santa Maria, RS.Case: In october 2010, a veterinary clinic of Santa Maria received a canine, female, Doberman, with two years of age. The animal had severe skin lesions on the head and limbs, pale mucous membranes, and enlarged lymph nodes. According to the owner, the animal showed progressive weight loss and anorexia for more than five days. During the clinical examination the blood was collected for hemogram and cytology of lymph nodes was performed by puncture aspiration with a fine needle. In the erythrogram, it was observed a decrease in the total number of erythrocytes (2.8 x 10(6)/mu L), hematocrit (21%), hemoglobin (6.8 g/dL) and platelets (98 x 10(3)/mu L). In the leucogram, any alteration was observed. The cytology of lymph nodes showed amastigotes forms, suggestive of the Leishmania spp. Based on this finding; we performed the blood collection for PCR, to confirm parasitism and to determine the species of Leishmania. At the molecular test was used PCR-specific for L. chagasi, and the result was positive.Discussion: This is the first autochthonous clinical case in the central region of the RS, non-endemic area for leishmaniasis. In serological studies of visceral leishmaniasis it was diagnosed in five asymptomatic dogs in the municipalities of Santa Maria, Julio de Castilhos and Itaara, however not confirmed by molecular analysis. In the municipalities of Cruz Alta and Uruguaiana cases of L. chagasi have been reported in dogs which previously resided in Leishmania sp. endemic areas. The municipality of Sao Borja had the first record of L. longipalpis in the RS during the leishmaniasis outbreak in 2008-2009. In the central region of the RS vector has not been found, but because in this first autochthonous case dog in Santa Maria believe that the parasite is present and/or doing other insect transmission of leishmaniasis. Clinical signs associated with hematologic and coagulation disorders observed in the canine are commonly described in symptomatic dogs in endemic regions. This case of autochthonous leishmaniasis reinforces the idea of the vector presence in Santa Maria, center of the RS. We believe that canine leishmaniasis is an emerging disease in the southern region of Brazil.

Taenia solium DNA is present in the cerebrospinal fluid of neurocysticercosis patients and can be used for diagnosis

Neurocysticercosis is the most frequent parasitic infection of the CNS and the main cause of acquired epilepsy worldwide. Seizures are the most common symptoms of the disease, together with headache, involuntary movements, psychosis and a global mental deterioration. Absolute diagnostic criteria include the identification of cysticerci, with scolex, in the brain by MRI imaging. We demonstrate here, for the first time, that T. solium DNA is present in the cerebrospinal fluid of patients. The PCR amplification of the parasite DNA in the CSF enabled the correct identification of 29/30 cases (96.7 %). The PCR diagnosis of parasite DNA in the CSF may be a strong support for the diagnosis of neurocysticercosis.

Cordia verbenacea and secretion of mast cells in different animal species

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Phospholipase A(2) myotoxins from Bothrops snake venoms: Structure-function relationship

Phospholipases A(2) constitute the major components from Bothrops snake venoms and have been extensively investigated not only because they are relatively very abundant in these venoms but mainly because they display a range of many relevant biological effects, including: myotoxic, cytotoxic, edema-inducing, artificial membrane disrupting, anticoagulant, neuromuscular, platelet aggregation inhibiting, hypotensive, bactericidal, anti-HIV, anti-tumoural, anti-malarial and anti-parasitic. The primary structures of several PLA(2)s have been elucidated through direct amino acid sequencing or, inderectly, through the corresponding nucleotide sequencing. Two main subgroups were thus described: (i) Asp49 PLA(2)s, showing low (basic, highly myotoxic) to relatively high (acidic, less or non myotoxic) Ca++-dependent hydrolytic activity upon artificial substrates; (ii) Lys49 PLA(2)s (basic, highly myotoxic) , showing no detectable hydrolytic activity on artificial substrates. Several crystal structures of Lys49 PLAs from genus Bothrops have already been solved, revealing very similar fold patterns. Lack of catalytic activity of myotoxic Lys49-PLA(2)s, first related solely with the fact that Lys49 occupies the position of the calcium ion in the catalyticly active site of Asp49 PLA(2)s, is now also attributed to Lys122 which interacts with the carbonyl of Cys29 hyperpolarising the peptide bond between Cys29 and Gly30 and trapping the fatty acid product in the active site, thus interrupting the catalytic cycle. This hypothesis, supported for three recent structures, is also discussed here. All Asp49 myotoxins showed to be pharmacologically more potent when compared with the Lys49 variants, but phospholipid hydrolysis is not an indispensable condition for the myotoxic, cytotoxic, bactericidal, anti-HIV, anti-parasitic, liposome disrupting or edema-inducing activities. Recent studies on site directed mutagenesis of the recombinant Lys49 myotoxin from Bothrops jararacussu revealed the participation of important amino acid residues in the membrane damaging and myotoxic activities.

LaTBP1: A Leishmania amazonensis DNA-binding protein that associates in vivo with telomeres and GT-rich DNA using a Myb-like domain

Different species of Leishmania can cause a variety of medically important diseases, whose control and treatment are still health problems. Telomere binding proteins (TBPs) have potential as targets for anti-parasitic chemotherapy because of their importance for genome stability and cell viability. Here, we describe LaTBP1 a protein that has a Myb-like DNA-binding domain, a feature shared by most double-stranded telomeric proteins. Binding assays using full-length and truncated LaTBP1 combined with spectroscopy analysis were used to map the boundaries of the Myb-like domain near to the protein only tryptophan residue. The Myb-like domain of LaTBP1 contains a conserved hydrophobic cavity implicated in DNA-binding activity. A hypothetical model helped to visualize that it shares structural homology with domains of other Myb-containing proteins. Competition assays and chromatin immunoprecipitation confirmed the specificity of LaTBP1 for telomeric and GT-rich DNAs, suggesting that LaTBP1 is a new TBP. (C) 2007 Elsevier B.V. All rights reserved.