Leishmania chagasi infection in cats with dermatologic lesions from an endemic area of visceral leishmaniosis in Brazil

Although dogs are considered the main domestic reservoirs for Visceral Leishmaniosis (VL), which is caused in the Americas by Leishmania chagasi, infected cats have also been recently found in endemic areas of several countries and became a public health concern. Accordingly, the purpose of this study was to evaluate cats with dermatologic lesions from an endemic area of VL and the natural infection of L. chagasi. A total of 55 cats were selected between April 2008 and November 2009 from two major animal shelters of Aracatuba, Southeastern Brazil. All cats underwent general and dermatologic examinations, followed by direct parasitological examination of lymphoid organs, immunosorbent assay (ELISA) and indirect immunofluorescence (IFAT). In addition, detection of amastigotes was performed by immunohistochemistry (IHC) in skin lesions of all cats. VL was diagnosed in 27/55 (49.1%) cats with dermatological problems. Amastigotes were found in lymphoid organs of 10/27 (37.0%) cats; serology of 14/27 (51.9%), 6/27 (22.2%) and 5/27 (18.5%) cats was positive for ELISA, IFAT and both, respectively. The IHC identified 9/27 (33.3%) cats; 5/27 (18.5%) were positive only for IHC and therefore increased the overall sensitivity. Specific FIV antibodies were found in 6/55(10.9%) cats, of which 5/6 (83.3%) had leishmaniosis. Real time PCR followed by amplicon sequencing successfully confirmed L chagasi infection. In conclusion, dermatological lesions in cats from endemic areas was highly associated to visceral leishmaniosis, and therefore skin IHC and differential diagnosis of LV should be always conducted in dermatological patients in such areas. (c) 2011 Elsevier B.V. All rights reserved.

Leishmania chagasi infection in cats with dermatologic lesions from an endemic area of visceral leishmaniosis in Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Leishmania chagasi infection in cats with dermatologic lesions from an endemic area of visceral leishmaniosis in Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Human T-cell lymphotropic virus type 1 infective dermatitis emerging in adulthood

Background Infective dermatitis (ID) is a rare dermatologic condition of childhood that has been linked to human T-cell lymphotropic virus type 1 (HTLV-1). Objective To analyze the clinical and laboratory features associated with adult-onset ID linked to HTLV-1. Methods From December 1995 to December 2007, four patients with ID were followed in the dermatology outpatient clinic of the ""Hospital das Clinicas"" of the University of Sao Paulo Medical School, Sao Paulo, Brazil. Epidemiologic data were collected and dermatologic examination was performed. Patients were submitted to histopathologic, hematologic, virologic, and immunologic investigations. Results All patients had a diagnosis of ID according to previously established criteria, despite being adults. HTLV-1 infection was demonstrated by enzyme-linked immunosorbent assay, Western blotting assays, and polymerase chain reaction. The male to female ratio was 1 : 3 and the median age at diagnosis was 42 years. The cutaneous manifestations were erythematous, scaly, and crusted lesions in all patients, and ichthyosis in three of the four cases. Histopathologic study showed lymphocytic epidermotropism in two cases. The median proviral load was 281 copies/10,000 peripheral blood mononuclear cells. Immunodeficiency was not observed in any case. The therapies used were antimicrobials, corticosteroids, and phototherapy. Conclusions Although many authors have considered ID to be a form of childhood dermatitis, we have described four cases that fulfilled the major criteria for ID, except for onset in adulthood.

Cybertutor: a teaching tool in Dermatology

It was developed a teaching tool in Dermatology for undergraduate medical students, using an interactive website, the Cybertutor. Clinical cases, lectures and updated bibliography were selected. Photographies of dermatological lesions were taken from ambulatory patients. The topics of the lectures were based on the current curriculum of the Federal University of Rio Grande do Sul. The Cybertutor is a dynamic and modern teaching tool, allowing constant innovation.

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.

Manifestações mucocutâneas de histoplasmose na AIDS : avaliação de 36 pacientes

Introdução: A histoplasmose é uma infecção geralmente subclínica e autolimitada em pacientes imunocompetentes. A maioria dos pacientes com HIV apresenta a forma disseminada da doença, considerada definidora de aids. As manifestações cutâneo-mucosas da histoplasmose são variadas, dificultando o diagnóstico. Métodos: Estudo retrospectivo de 24 pacientes com diagnóstico de histoplasmose, avaliados no serviço de Dermatologia do Hospital de Clínicas de Porto Alegre, de 2000 a 2003 e, prospectivamente, mais 12 pacientes, atendidos em 2004 e 2005. A análise considerou dados epidemiológicos e demográficos, bem como os parâmetros clínicos, distribuição e morfologia das lesões, contagem de células CD4+, terapia da micose e antirretroviral e se a doença foi a definidora de aids. Resultados: Vinte e seis (72%) doentes eram homens. A idade média foi 34 anos (17-58) e 16 pacientes (49%) tiveram seus diagnósticos realizados de dezembro a março, no verão. A histoplasmose foi confirmada por biópsia cutânea em 33 casos e por cultura em 23 deles. Onze pacientes recebiam antirretrovirais no momento do diagnóstico e a sua contagem de células CD4+ variou de 2 a 103 (média 29 células/mm³). Não houve diferenças significativas em relação a sexo, idade, método diagnóstico e uso de antirretrovirais entre a amostra retrospectiva e prospectiva. O número médio de lesões foi 2,7, variando de 1 a 7 tipos diferentes em um mesmo paciente. Pápulas com crosta e erosão/úlcera de mucosa foram as mais frequentes, em 64% e 58% dos pacientes, respectivamente. Uma distribuição difusa foi a mais comum, em mais de 58% dos casos. Houve uma associação significativa entre a contagem de células CD4+ e a variabilidade morfológica de lesões por paciente, sendo que um menor polimorfismo de lesões está associado a contagens mais baixas de células CD4+. Conclusão: A familiaridade com as manifestações dermatológicas da histoplasmose é importante para uma maior suspeição tanto da doença, quanto do próprio HIV. Pápulas com crostas difusas e erosão/úlcera de mucosa, no verão, em pacientes com aids e contagem de células CD4+ menor do que 50 células/ mm³ são achados muito sugestivos de histoplasmose. Porém, é de suma importância a realização de exames complementares para a exclusão dos outros diagnósticos diferenciais. A maior variabilidade morfológica das lesões nos pacientes com menor comprometimento imunológico (CD4 maior) poderia ser devido à necessidade de um certo grau de imunidade na gênese das lesões cutâneas.

Associação entre acrocórdons e resistência à insulina

FUNDAMENTOS: Acrocórdons são lesões dermatológicas comuns na população e estão associados ao diabetes mellitus, à obesidade, à resistência insulínica e à aterosclerose. A identificação precoce de pacientes com resistência insulínica pode ter papel preventivo primário. OBJETIVO: Avaliar a associação entre presença de acrocórdons cervicais ou axilares e resistência insulínica. MÉTODOS: Estudo transversal com pacientes dermatológicos adultos atendidos em hospital universitário. Casos foram definidos como portadores de mais de cinco acrocórdons cervicais e/ou axilares. A resistência insulínica foi estimada pelo índice HOMA-IR. Resultados foram ajustados pelas demais covariáveis de risco para resistência insulínica conhecidos, a partir de regressão logística múltipla. RESULTADOS: Avaliaram-se 98 casos e 103 controles, que não diferiram entre si quanto à idade ou ao gênero. Acrocórdons se associaram diretamente aos valores de HOMA-IR (Odds Ratio = 1,4), hipertrigliceridemia e índice de massa corpórea, independentemente do ajuste por diabetes mellitus, idade, fototipo, gênero, história de diabetes mellitus familiar e relação cintura/quadril. Níveis qualitativamente elevados de HOMA-IR (> 3,8) também evidenciaram associação significativa (Índice de probabilidade = 7,5). CONCLUSÕES: Presença de múltiplos acrocórdons se associou à resistência insulínica, independentemente dos demais fatores de risco.

Clinical, histological and immunophenotypic findings in a mare with a mammary lymphoma associated with anaemia and pruritus

An 18-year-old Quarter Horse mare presented with an 18 week history of dermatological lesions characterised by recurrent urticaria and recent signs of enlarged mammary glands, pyrexia, alopecia and intense pruritus. Haematological and serum biochemical analyses revealed anaemia, leucocytosis, thrombocytopenia and hyperfibrinogenaemia. Mammary discharge was evaluated and revealed neutrophilia. Cytological examinations of fine needle aspirates from the parotid lymph nodes were normal. Common causes of anaemia were ruled out by specific tests. The initial diagnosis was mastitis and 2 weeks later the animal returned to the hospital with worsening of clinical signs, intermittent fever, intense pruritus and generalised alopecia. Blood samples were collected for haematological and serum biochemical analyses, and the mammary gland and parotid lymph nodes were biopsied. Rectal palpation revealed a large irregular mass near the left kidney with adhesions of surrounding structures. The animal died before the laboratory results were ready. This report details the clinical, histological and immunophenotypic findings of a case of large lymphoma in a mare.

Skin lesions in envenoming by cnidarians (Portuguese man-of-war and jellyfish): etiology and severity of accidents on the Brazilian coast

This work attempts to establish dermatological identification patterns for Brazilian cnidarian species and a probable correlation with envenoming severity. In an observational prospective study, one hundred and twenty-eight patients from the North Coast region of São Paulo State, Brazil were seen between 2002 and 2008. About 80% of these showed only local effects (erythema, edema, and pain) with small, less than 20 cm, oval or round skin marks and impressions from small tentacles. Approximately 20% of the victims had long, more than 20 cm, linear and crossed marks with frequent systemic phenomena, such as malaise, vomiting, dyspnea, and tachycardia. The former is compatible with the common hydromedusa from Southeast and Southern Brazil (Olindias sambaquiensis). The long linear marks with intense pain and systemic phenomena are compatible with envenoming by the box jellyfish Tamoya haplonema and Chiropsalmus quadrumanus and the hydrozoan Portuguese man-of-war (Physalis physalis). There was an association between skin marks and probable accident etiology. This simple observation rule can be indicative of severity, as the Cubozoa Class (box jellyfish) and Portuguese man-of-war cause the most severe accidents. In such cases, medical attention, including intensive care, is important, as the systemic manifestations can be associated with death.

Skin lesions in envenoming by cnidarians (Portuguese man-of-war and jellyfish): etiology and severity of accidents on the Brazilian coast

This work attempts to establish dermatological identification patterns for Brazilian enidarian species and it probable correlation with envenoming, severity In all observational prospective study, one hundred and twenty-eight patients from the North Coast re-ion of São Paulo State, Brazil were seen between 2002 and 2008. About 80% of these Showed only local effects (erythema, edema, and pain) with small, less than 20 cm, oval or round skin marks and impressions from Small tentacles. Approximately 20% of the victims had long, more than 20 cm, linear and crossed marks with frequent systemic phenomena, such as malaise, vomiting, dyspnea, and tachycardia. The former is compatible with the common hydromedusa from Southeast and Southern Brazil (Olindias sambaquiensis). The long linear marks with intense pain and systemic phenomena are compatible with envenoming, by the box jellyfish Tamoya haplonema and Chiropsalmus quadrumanus and the hydrozoan Portuguese man-of-war (Physalis physalis). There was an association between Skin marks and probable accident etiology. This simple observation rule can be indicative of severity as the Cubozoa Class (box jellyfish) and Portuguese man-of-war cause the most severe accidents. In such cases, medical attention, including intensive care, is important, as the systemic manifestations call be associated with death.

Prevalence of precancerous skin lesions and non-melanoma skin cancer in Japanese-Brazilians in Bauru, São Paulo State, Brazil

Manifestações cutâneas pré-neoplásicas e neoplásicas em asiáticos são infreqüentes e pouco documentadas. O Brasil possui o maior contingente de imigrantes japoneses e 70% deles residem no Estado de São Paulo. A prevalência dessas lesões em nipo-brasileiros é desconhecida. O presente estudo tem como objetivo avaliar a prevalência de queratoses actínicas e tumores cutâneos não melanomas em nipo-brasileiros acima de trinta anos de 1ª geração ou 2ª geração, sem miscigenação, residentes na cidade de Bauru, no ano de 2006. Dos 567 nipo-brasileiros submetidos a exame dermatológico, diagnosticou-se queratose actínica em 76 pacientes, com média de idade de 68,9 anos, e único carcinoma basocelular em paciente do sexo feminino de 39 anos. No Japão, a prevalência de queratose actínica é de 0,76% a 5% e a incidência de tumores cutâneos não melanomas é de 1,2 a 5,4/100 mil. Os nipo-brasileiros de Bauru apresentaram prevalência de 13,4% de queratoses actínicas e idade mais precoce de aparecimento. Proximidade com o Equador e atividades rurais contribuem para esses achados. A presença de melanose solar demonstrou risco 1,9 vez maior de desenvolver queratose actínica.

S-nitrosoglutathione (gsno) Is Cytotoxic To Intracellular Amastigotes And Promotes Healing Of Topically Treated Leishmania Major Or Leishmania Braziliensis Skin Lesions-authors' Response.

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Tubular Variant Of Basal Cell Adenoma Shares Immunophenotypical Features With Normal Intercalated Ducts And Is Closely Related To Intercalated Duct Lesions Of Salivary Gland.

The morphological criteria for identification of intercalated duct lesions (IDLs) of salivary glands have been defined recently. It has been hypothesised that IDL could be a precursor of basal cell adenoma (BCA). BCAs show a variety of histological patterns, and the tubular variant is the one that presents the strongest resemblance with IDLs. The aim of this study was to analyse the morphological and immunohistochemical profiles of IDLs and BCAs classified into tubular and non-tubular subtypes, to determine whether or not IDL and tubular BCA represent distinct entities. Eight IDLs, nine tubular BCAs and 19 non-tubular BCAs were studied. All tubular BCAs contained IDL-like areas, which represented 20-70% of the tumour. In non-tubular BCA, IDL-like areas were occasional and small (<5%). One patient presented IDLs, tubular BCAs and IDL/tubular BCA combined lesions. Luminal ductal cells of IDLs and tubular BCAs exhibited positivity for CK7, lysozyme, S100 and DOG1. In the non-tubular BCA group, few luminal cells exhibited such an immunoprofile; they were mainly CK14-positive. Basal/myoepithelial cells of IDLs, tubular BCAs and non-tubular BCAs were positive for CK14, calponin, α-SMA and p63; they were more numerous in BCA lesions. IDL, tubular BCA and non-tubular BCA form a continuum of lesions in which IDLs are related closely to tubular BCA. In both, the immunoprofile of luminal and myoepithelial cells recapitulates the normal intercalated duct. The difference between the adenoma-like subset of IDLs and tubular BCA rests mainly on the larger numbers of myoepithelial cells in the latter. Our findings indicate that at least some BCAs can arise via IDLs.