Rendu-Osler-Weber syndrome: dermatological approach

The Rendu-Osler-Weber syndrome is a rare systemic fibrovascular dysplasia, recognized by mucocutaneous telangiectasias, arteriovenous malformations, epistaxis and family history. Recurrent bleeding, hypoxemia, congestive heart failure, portosystemic encephalopathy, and symptoms related to angiodysplasia of the central nervous system may occur. Since the treatment is based on supportive measures, early recognition is of utmost importance. This article reports the case of a 53-year-old male patient who presented telangiectasias on fingers, oral cavity and nasal mucosa for 10 years, with a history of recurrent epistaxis of varying severity since childhood. Mother, sister and daughter have similar lesions.

Brazilian Spotted Fever: the importance of dermatological signs for early diagnosis

Brazilian spotted fever is an acute febrile infectious disease caused by Rickettsia rickettsii, transmitted by tick bite. As this disease is rare and has high mortality rates in Brazil, the clinical aspects and epidemiological data may help the diagnosis. We report a case of Brazilian spotted fever in a 19-year-old patient who presented maculopapular exanthema in the palmar region and upper limbs, lymphadenopathy, fever, chills, headache, conjunctival hyperemia, nausea, vomiting, dyspnea, myalgia, developing neurological signs and abdominal pain. He was treated with doxycycline with clinical improvement. We emphasize the importance of the recognition of this disease by dermatologists as cutaneous manifestations are the key findings to establish early diagnosis and prevent complications.

American tegumentary leishmaniasis - a case of therapeutic challenge

American Tegumentary Leishmaniasis (ATL) is a chronic, non-contagious, infectious disease affecting millions of people worldwide. The timely and proper treatment is of great importance to prevent the disease from progressing to destructive and severe forms. Treatment for ATL recommended by the Brazilian Ministry of Health is similar for the whole country, regardless of the species of Leishmania. It is known that the response to treatment may vary with the strain of the parasite, the immune status of the patient and clinical form. We report the case of a healthy patient, coming from Manaus, Amazonas state, Brazil, who presented resistance to treatment with N-methyl-glutamine and liposomal amphotericin B, only being healed after using pentamidine.

Verrucous lepromatous leprosy: a rare form of presentation - Report on two cases

Leprosy skin lesions are described as hypochromic or erythematous macules, pale erythematous or reddish-brown plaques, papules, nodules, and diffuse cutaneous infiltration, depending on the clinical form of the disease. They may be accompanied by hypo or anesthesia, alopecia, and hypo or anhidrosis. Verrucous lesions are now quite uncommon in leprosy. The literature is sparse, with only 25 reported cases of this association, especially in the lepromatous pole of the disease. This work is a report on two cases of lepromatous leprosy of long evolution, coursing with vegetant verrucous lesions.

Estudo comparativo de sintomas respiratórios e função pulmonar em pacientes com doença pulmonar obstrutiva crônica relacionada à exposição à fumaça de lenha e de tabaco / Comparative study of respiratory symptoms and lung function alterations in patients with chronic obstructive pulmonary disease related to the exposure to wood and tobacco smoke

OBJETIVO: Descrever e analisar sintomas respiratórios e alterações espirométricas em pacientes portadores de doença pulmonar obstrutiva crônica (DPOC), com história de exposição à fumaça de lenha e de tabaco. MÉTODOS: Foram avaliados retrospectivamente dados de 170 pacientes distribuídos em 3 grupos: 34 pacientes expostos somente à fumaça de lenha, 59 pacientes, somente à de tabaco e 77 pacientes expostos a ambas. RESULTADOS: Os grupos não diferiram quanto a idade (p = 0,225) e grau de exposição, considerando cada tipo de exposição isoladamente ou em associação (p = 0,164 e p = 0,220, respectivamente). No grupo exposto à fumaça de lenha predominou o sexo feminino.Não houve diferença entre os grupos quanto à freqüência dos sintomas respiratórios (p > 0,05), e houve predominância de grau moderado de dispnéia nos três grupos (p = 0,141). O grupo exposto à fumaça de lenha apresentou melhores percentuais da relação volume expiratório forçado no primeiro segundo/capacidade vital forçada e de volume expiratório forçado no primeiro segundo (p < 0,05). A prova broncodilatadora positiva ocorreu com maior freqüência no grupo exposto ao tabaco.O percentual de obstrução brônquica grave e muito grave foi significantemente maior no grupo exposto ao tabaco (44,1 por cento) que no grupo exposto somente à fumaça de combustão de lenha (11,8 por cento; p = 0,006). CONCLUSÕES: Os sintomas respiratórios e alterações da função pulmonar compatíveis com DPOC foram observados nos grupos expostos à fumaça de lenha. Todavia, estas alterações foram menos intensas do que as observadas nos grupos expostos ao tabaco.Este trabalho ressalta a importância de realizar-se um estudo prospectivo para avaliar o risco de DPOC associado à exposição à fumaça de lenha no Brasil assim como a necessidade de ações preventivas neste âmbito.

OBJECTIVE: To describe and analyze clinical symptoms and spirometric alterations of patients with chronic obstructive pulmonary disease (COPD) and history of exposure to wood and tobacco smoke. METHODS: We retrospectively evaluated data related to 170 patients distributed into 3 groups: 34 exposed only to wood smoke, 59 patients exposed only to tobacco smoke and 77 patients exposed to both. RESULTS: The groups did not differ significantly in terms of age (p = 0.225) or degree of exposure, considering each type of exposure in isolation or in combination (p = 0.164 and p = 0.220, respectively). Females predominated in the group exposed to wood smoke. There were no differences among the groups regarding respiratory symptoms (p > 0.05), and moderate dyspnea predominated in the three groups (p = 0.141). The group exposed to wood smoke presented higher percentages of forced expiratory volume in one second/forced vital capacity ratio and of forced expiratory volume in one second (p < 0.05). Positive results on bronchodilator testing occurred more frequently in the group exposed to tobacco smoke. The percentage of severe and extremely severe obstruction was significantly higher in the group exposed to tobacco smoke (44.1 percent) than in that exposed to wood smoke (11.8 percent; p = 0.006). CONCLUSIONS: Respiratory symptoms and pulmonary function alterations consistent with COPD were observed in the groups of patients exposed to wood smoke. However, those alterations were not as significant as the alterations observed in the groups exposed to tobacco smoke. This study emphasizes the importance of prospective studies in evaluating the risk of wood-smoke-related COPD in Brazil, as well as the need for preventive measures in this area.

Etiologia e suscetibilidade a antimicrobianos dos agentes da mastite bovina isolados na região de Pirassununga- SP-Brasil / Etiology and susceptibility in vitro of the bovine mastitis agents isolated from cattle in the Region of Pirassununga (SP)-Brazil

No período de setembro a novembro de 2000, 543 amostras de leite cru foram analisadas na Universidade de São Paulo-Pirassununga, com o objetivo de conhecer a etiologia e a suscetibilidade in vitro dos agentes da mastite infecciosa bovina, além de estabelecer uma relação entre os agentes identificados e a forma de apresentação da enfermidade. Os microrganismos foram clutivados em ágar sangue de carneiro e identificados por suas características macroscópicas, microscópicas e bioquímicas. Os antibiogramas foram realizados em ágar Mueller Hinton, método de difusão de disco. Os agentes isolados foram: Corynebacterium spp, em 51,4 por cento das amostras; Staphylococcus spp, em 40,3 por cento (71,9 por cento coagulase positiva); Streptococcus spp, em 17,5 por cento (desses, 63,8 por cento eram Streptococcus agalactiae); e ainda, Nocardia spp, leveduras e gram-negativos (50,0 por cento eram Escherichia coli). Foram isoladas 603 cepas, observando-se o predomínio de agentes contagiosos (94,5 por cento sendo 49,0 por cento Corynebacterium spp). Entre os ambientais houve predomínio de Streptococcus uberis (69,7 por cento). Staphylococcus spp, Streptococcus spp, Nocardia spp e leveduras estavam mais associados à mastite subclínica, enquanto Corynebacterium spp ao quadro de animais portadores e gram-negativos à mastite clínica. Entre os agentes avaliados, as cepas de Corynebacterium spp apresentaram a maior suscetibilidade.