ABSTRACT
OBJECTIVE: Immunosuppressed patients are at risk of microsporidiosis, and this parasitosis has an increased rate of dissemination in this population. Our objective was to evaluate the presence of microsporidiosis and other intestinal parasites in rheumatic disease patients undergoing anti-tumor necrosis factor/disease-modifying anti-rheumatic drug treatment. METHODS: Ninety-eight patients (47 with rheumatoid arthritis, 31 with ankylosing spondylitis and 11 with psoriatic arthritis) and 92 healthy control patients were enrolled in the study. Three stool samples and cultures were collected from each subject. RESULTS: The frequency of microsporidia was significantly higher in rheumatic disease patients than in control subjects (36 vs. 4 percent, respectively; p<0.0001), as well as in those with rheumatic diseases (32 vs. 4 percent, respectively; p<0.0001), ankylosing spondylitis (45 vs. 4 percent, respectively; p<0.0001) and psoriatic arthritis (40 vs. 4 percent, respectively; p<0.0001), despite a similar social-economic class distribution in both the patient and control groups (p = 0.1153). Of note, concomitant fecal leukocytes were observed in the majority of the microsporidia-positive patients (79.5 percent). Approximately 80 percent of the patients had gastrointestinal symptoms, such as diarrhea (26 percent), abdominal pain (31 percent) and weight loss (5 percent), although the frequencies of these symptoms were comparable in patients with and without this infection (p>0.05). Rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis disease activity parameters were comparable in both groups (p>0.05). The duration of anti-tumor necrosis factor/disease-modifying anti-rheumatic drugs and glucocorticoid use were also similar in both groups. CONCLUSION: We have documented that microsporidiosis with intestinal mucosa disruption is frequent in patients undergoing concomitant anti-tumor necrosis factor/disease-modifying anti-rheumatic drug therapy. Impaired host defenses due to the combination of the underlying disease and the immunosuppressive therapy is the most likely explanation for this finding, and this increased susceptibility reinforces the need for the investigation of microsporidia and implementation of treatment strategies in this population.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Antirheumatic Agents/adverse effects , Intestinal Diseases/microbiology , Microsporidiosis/immunology , Rheumatic Diseases/drug therapy , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Case-Control Studies , Drug Therapy, Combination/adverse effects , Immunocompromised Host/immunology , Immunosuppressive Agents/adverse effects , Risk Factors , Rheumatic Diseases/immunology , Socioeconomic Factors , Statistics, NonparametricABSTRACT
A piomiosite é uma infecção primária do músculo esquelético mais comum nos países tropicais. Adultos que desenvolvem a doença apresentam, na maioria dos casos, comorbidades associadas que comprometem o sistema imunológico, entre elas diabetes mellitus e cirrose hepática.
Pyomyositis is a primary infection of the skeletal muscle, occurring most commonly in tropical countries. Adults who develop the disease have, in most cases, associated comorbidities that compromise the immune system, including diabetes mellitus and liver cirrhosis.
Subject(s)
Adult , Female , Humans , /complications , Liver Cirrhosis/complications , Pyomyositis/etiologyABSTRACT
A silicoesclerodermia, descrita inicialmente por Erasmus em 1957, é o resultado da interferência na imunidade celular relacionada à citotoxicidade da sílica, responsável pelas reações auto-imunes e pela formação de imunocomplexos circulantes. Neste relato, os autores descrevem o caso de um homem de 61 anos com antecedentes de exposição à sílica e que desenvolveu Síndrome de Erasmus.
Silicoscleroderma, described by Erasmus in 1957, is the result of cellular immunity interference related to the cytotoxicity of silica, and it is responsible for autoimmune reactions and formation of circulating immunecomplexes. In this text, the authors describe a 61-years-old man with previous exposure to silica, and who developed Erasmus syndrome.
Subject(s)
Humans , Male , Middle Aged , Scleroderma, Systemic/complications , Pneumoconiosis/diagnosis , Silicosis/complicationsABSTRACT
Os autores relatam o caso de uma paciente com 19 anos de idade, portadora de lúpus eritematoso sistêmico, que apresentou edema súbito e progressivo em membro supeior esquerdo e dor e circulação colateral visível em região supraclavicular esquerda. Foi realizado diangóstico de trombose venosa em veia jugular externa esquerda por meio do dúplex scan. Nos exames laboratoriais, evidenciou-se a presença de anticorpo anticardiolipina
Subject(s)
Humans , Female , Adult , Antibodies, Anticardiolipin , Jugular Veins , Lupus Erythematosus, Systemic , Venous ThrombosisABSTRACT
Os autores apresentam o caso de uma paciente de 48 anos de idade com quadro de pinçamento aorto-mesentérico como complicação de esclerose sistêmica progressiva forma CREST. A paciente preencheu todos os critérios diagnósticos para a patologia de base e durante a evolução do caso, já com dismotilidade esofágica e síndrome desabsotiva, e após emagrecimento acentuado e rápido, apresentou quadro de abdome agudo em decorrência de pinçamento aorto-mesentérico. Chama-se atenção apra raridade desta complicação, e ainda pela alta morbidade causada pelo comprometimento sistêmico da Esclerose Sistêmica Progressiva (E.S.P.).
Subject(s)
Humans , Female , Middle Aged , Aorta/physiopathology , Mesenteric Arteries/physiopathology , Scleroderma, Systemic/complications , Constriction, Pathologic/etiology , Esophageal Motility DisordersABSTRACT
O caso de poliarterite nodosa (PAN) em paciente de 54 anos de idade é relatado. O quadro clínico evidenciava polineuropatia sensitivo-motora clássica de 6 meses de evoluçäo, associado a emagrecimento acentuado, adinamia artralgia, mialgia, taquicardia, febre e hipertensäo arterial. Os exames complementares iniciais revelaram leucocitose, VHS elevado, HBAg positiva e pesquisa de crioglobulinas positiva. O estudo angiográfico visceral na circulaçäo renal e hepática revelou presença de inúmeros aneurismas sendo o diagnóstico confirmado. O paciente evoluiu para óbito após cerca de duas semanas. É feita breve revisäo sobre PAN, salientando-se a importância da detecçäo de HBAg na etiopatogênese e do estudo angiográfico para o diagnóstico