Cardiovascular events associated with thalidomide and prednisone in leprosy type 2 reaction

Abstract Background: Thalidomide is the drug of choice for the treatment of type 2 leprosy reactions and is often associated with corticosteroids. The use of these drugs in multiple myeloma is associated with the risk of cardiovascular events, but there have been few studies assessing this risk in leprosy patients. Objective: To evaluate the occurrence of cardiovascular events in patients with multibacillary leprosy and their correlation with the use of thalidomide and prednisone. Methods: Analytical cross-sectional study of all patients diagnosed with multibacillary leprosy treated at the Dermatology Service between 2012 and 2022, using electronic medical records. Thromboembolic vascular events, both arterial and venous, including acute myocardial infarction, were considered. The main independent variable was the concomitant use of thalidomide and prednisone during follow-up. Results: A total of 89 patients were included, of which 19 used thalidomide and prednisone concomitantly. There were five cardiovascular events (26.3%), three of which of deep venous thrombosis. The combined use of medications was associated with the events (PR = 6.46 [3.92 to 10.65]; p<0.01). Study limitations: Small number of events, single-center retrospective study. Conclusion: The hypothesis of an association between cardiovascular events and the concomitant use of thalidomide and prednisone is supported, but more robust prospective studies are required for a better assessment.

Lepromatous leprosy, melanoma, and basal cell carcinoma: clinical-histopathologic association

Abstract Cutaneous neoplasms frequently occur in leprosy, but there are few reports of the coexistence of leprosy and basal cell carcinoma in the same lesion. This case reports a 49-year-old male with an ulcerated plaque on the right lateral nasal wall, bright papules on the sternal region, and a blackened plaque on the right temporal region. The nasal and temporal lesions were diagnosed by histopathology as basal cell carcinoma and melanoma, respectively. The sternal lesions were excised with the repair of the "dog ear" which histopathological examination showed macrophages in the dermis parasitized with acid-fast bacilli, confirming the diagnosis of lepromatous leprosy with Fite-Faraco staining. This case report highlights the importance of referring the dog-ear specimen for histopathologic analysis.

Effectiveness of the retreatment of patients with multibacillary leprosy and episodes of erythema nodosum leprosum and/or persistent neuritis: a single-center experience

Abstract: Background: Erythema nodosum leprosum may appear before, during or after treatment of leprosy and is one of the main factors for nerve damage in patients. When it occurs or continues to occur after treatment, it may indicate disease recurrence and a new treatment may be instituted again. Objective: To evaluate the retreatment of patients with multibacillary leprosy who underwent standard treatment with multidrug therapy, but developed or continued to present reactions of erythema nodosum leprosum and/or neuritis 3-5 years after its end. Method: For this objective, a new treatment was performed in 29 patients with multibacillary leprosy who maintained episodes of erythema nodosum and/or neuritis 3-5 years after conventional treatment. Results: In general, we observed that 27 (93.10%) had no more new episodes after a follow up period of eight months to five years. In five of these patients the reason for the retreatment was the occurrence of difficult-to-control neuritis, and that has ceased to occur in all of them. Study limitations: Small number of patients.. Conclusion: In the cases observed, retreatment was an effective measure to prevent the occurrence of erythema nodosum leprosum and/or persistent neuritis.

Epidemiological and geographical characterization of leprosy in a Brazilian hyperendemic municipality / Caracterização epidemiológica e geográfica da hanseníase em um município brasileiro hiperendêmico / Caracterización epidemiológica y geográfica de lepra en un municipio brasileño hiperendémico

Abstract: This study aimed to identify the distribution pattern of leprosy in a hyperendemic municipality in Brazil and determine its relationship with the clinico-epidemiological situation over 11 years. The geographic information system, MapInfo, spatial scan statistics and the Moran I index were used to analyze new cases. The digital cartographic base was used to map clusters of new paucibacillary and multibacillary cases and cases in minors under 15 years old. Socioeconomic indicators are shown using the choropleth mapping technique. A reduction in the detection coefficient, increases in high-risk spatial clusters, marked changes in the distribution of high-risk and low-risk clusters, and high-risk clusters of minors under 15 years old were observed from 2006 to 2010, showing recent illness, the presence of active foci, and overlapping of high-risk clusters of multibacillary infection in minors under 15 years old. Leprosy remains a public health problem in Rondonópolis, Mato Grosso State; the high-risk areas require an intensification of control measures and active search strategies to detect new cases.

Resumo: O estudo teve como objetivos identificar o padrão de distribuição da hanseníase em um município brasileiro hiperendêmico e determinar a relação com o quadro clínico-epidemiológico ao longo de 11 anos. Os casos novos foram analisados com o sistema de informação geográfica, MapInfo, estatística scan espacial e índice Moran I. A base cartográfica digital foi usada para mapear os clusters de casos paucibacilares e multibacilares novos e casos em menores de 15 anos. Os indicadores socioeconômicos são mostrados através da técnica de mapeamento coroplético. Entre 2006 e 2010, foram observados uma redução no coeficiente de detecção, aumento no clusters espaciais de alto risco, mudanças marcantes na distribuição de clusters de alto e baixo risco e clusters de alto risco em menores de 15 anos, sugerindo doença recente, a presença de focos ativos e a sobreposição de clusters de alto risco para infecção multibacilar em menores de 15 anos. A hanseníase persiste enquanto problema de saúde pública em Rondonópolis, Mato Grosso; as áreas de alto risco exigem a intensificação de medidas de controle, além de estratégias de busca ativa para detectar casos novos.

Resumen: Este estudio tuvo como objetivo identificar la distribución de los patrones de lepra en una municipalidad hiperendémica en Brasil y determinar su relación con la situación clínico-epidemiológica durante 11 años. El sistema de información geográfica, MapInfo, estadísticas de escaneo espacial y el índice de Moran se usaron para analizar nuevos casos. La base cartográfica digital se usó para mapear clústeres de nuevos casos multibacilares y paucibacilares, así como casos en menores por debajo de 15 años de edad. Los indicadores socioeconómicos se presentan usando la técnica de mapeo de coropletas. La reducción en la detección del coeficiente, se incrementa en los clústeres de alto riesgo espaciales, asimismo, se observaron de 2006 a 2010 cambios considerables en la distribución de los clústeres de alto riesgo y bajo riesgo, así como en clústeres de alto riesgo con menores con menos de 15 años de edad, mostrando los casos de enfermedad reciente la presencia de focos activos, así como solapando clústeres de alto riesgo de infección multibacilar en menores por debajo de los 15 años de edad. La lepra continúa siendo un problema de salud pública en Rondonópolis, Mato Grosso; las áreas de alto riesgo necesitan una intensificación de las medidas de control y una búsqueda activa de estrategias, con el fin de detectar nuevos casos.

Paracoccidioidomycosis with sarcoid-like lesions: a diagnostic challenge

Abstract Clinical presentation of paracoccidioidomycosis (PCM) can be diverse. Morphology and quantity of skin lesions depends on interactions between host immunity and fungus virulence. Diagnosis can be a challenge considering that this fungus has low virulence and some individuals have immunity to microorganism, which results in well-marked granulomas without visible microorganisms. We report herein a clinical presentation of sarcoid-like PCM, initially diagnosed as tuberculoid leprosy. This rare type of PCM is often mistaken for other types of chronic granulomatous diseases. Diagnosis was confirmed after 4 years when a special stain analysis helped in the identification of the specific etiologic agent.

Paracoccidioidomycosis: acute-subacute clinical form, juvenile type

Abstract: The authors report aspects of paracoccidioidomycosis, acute-subacute clinical form, juvenile type, in a 19-year-old female patient. Paracoccidioidomycosis, juvenile type, classically occurs in young patients, both sexes, with lymphoma-like aspects as initial presentation. However, following the natural history of the disease the lymph nodes assume patterns of infectious disease, as an abscess and fistulae. Systemic dissemination of the disease can occur and lethality and morbidity are significant in this clinical presentation.

Leprosy: a review of laboratory and therapeutic aspects - Part 2

Leprosy is a chronic infectious condition caused by Mycobacterium leprae(M. leprae). It is endemic in many regions of the world and a public health problem in Brazil. Additionally, it presents a wide spectrum of clinical manifestations, which are dependent on the interaction between M. leprae and host, and are related to the degree of immunity to the bacillus. The diagnosis of this disease is a clinical one. However, in some situations laboratory exams are necessary to confirm the diagnosis of leprosy or classify its clinical form. This article aims to update dermatologists on leprosy, through a review of complementary laboratory techniques that can be employed for the diagnosis of leprosy, including Mitsuda intradermal reaction, skin smear microscopy, histopathology, serology, immunohistochemistry, polymerase chain reaction, imaging tests, electromyography, and blood tests. It also aims to explain standard multidrug therapy regimens, the treatment of reactions and resistant cases, immunotherapy with bacillus Calmette-Guérin (BCG) vaccine and chemoprophylaxis.

Prevention of repeated episodes of type 2 reaction of leprosy with the use of thalidomide 100 mg/day

BACKGROUND: Leprosy can have its course interrupted by type 1 and 2 reactional episodes, the last named of erythema nodosum leprosum (ENL). Thalidomide has been the medication of choice for the control of ENL episodes since 1965. OBJECTIVES: These episodes can repeat and cause damages to the patient. In order to prevent these episodes, an extra dose of 100 mg/day thalidomide was used during six months, followed by a follow-up period of six more months after thalidomide discontinuation. METHODS: We included 42 patients with multibacillary (MB) leprosy who had episodes of ENL. They were male and female patients aged between 18 and 84 years. RESULTS: Of the 42 patients, 39 (92.85%) had the lepromatous form and three (7.15%) had the borderline form. We found that 100% of patients had no reactional episode during the use of the drug. During the follow-up period after thalidomide discontinuation, 33 (78.57%) patients had no reactional episode and nine (21.43%), all of them with the lepromatous form, had mild episodes, which were controlled using non-steroidal anti-inflammatory. There were no thalidomide-related side effects. CONCLUSION: A maintenance dose of 100 mg/day of thalidomide showed to be effective to prevent repeated type 2 reactional episodes of ENL. .

Leprosy: review of the epidemiological, clinical, and etiopathogenic aspects - Part 1

Leprosy is caused by Mycobacterium leprae and has been known since biblical times. It is still endemic in many regions of the world and a public health problem in Brazil. The prevalence rate in 2011 reached 1.54 cases per 10,000 inhabitants in Brazil. The mechanism of transmission of leprosy consists of prolonged close contact between susceptible and genetically predisposed individuals and untreated multibacillary patients. Transmission occurs through inhalation of bacilli present in upper airway secretion. The nasal mucosa is the main entry or exit route of M. leprae. The deeper understanding of the structural and biological characteristics of M. leprae, the sequencing of its genome, along with the advances in understanding the mechanisms of host immune response against the bacilli, dependent on genetic susceptibility, have contributed to the understanding of the pathogenesis, variations in the clinical characteristics, and progression of the disease. This article aims to update dermatologist on epidemiological, clinical, and etiopathogenic leprosy aspects.

Lepromatous leprosy and perianal tuberculosis: a case report and literature review

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, a microorganism that usually affects skin and nerves. Although it is usually well-controlled by multidrug therapy (MDT), the disease may be aggravated by acute inflammatory reaction episodes that cause permanent tissue damage particularly to peripheral nerves. Tuberculosis is predominantly a disease of the lungs; however, it may spread to other organs and cause an extrapulmonary infection. Both mycobacterial infections are endemic in developing countries including Brazil, and cases of coinfection have been reported in the last decade. Nevertheless, simultaneous occurrence of perianal cutaneous tuberculosis and erythema nodosum leprosum is very rare, even in countries where both mycobacterial infections are endemic.(AU)

Lepromatous leprosy and perianal tuberculosis: a case report and literature review

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, a microorganism that usually affects skin and nerves. Although it is usually well-controlled by multidrug therapy (MDT), the disease may be aggravated by acute inflammatory reaction episodes that cause permanent tissue damage particularly to peripheral nerves. Tuberculosis is predominantly a disease of the lungs; however, it may spread to other organs and cause an extrapulmonary infection. Both mycobacterial infections are endemic in developing countries including Brazil, and cases of coinfection have been reported in the last decade. Nevertheless, simultaneous occurrence of perianal cutaneous tuberculosis and erythema nodosum leprosum is very rare, even in countries where both mycobacterial infections are endemic.

Tratamento de queloides usando radioterapia pósoperatória com elétrons: estudo comparativo e randomizado com dois esquemas / Keloid treatment using postoperative radiotherapy with electron beams: a comparative randomized study of two methods

Introdução: As diversas modalidades de tratamento para queloides isoladamente apresentam resultados desapontadores. O tratamento combinado de excisão cirúrgica e irradiação pós-operatória com elétrons é efetivo para a qualidade da cicatriz e redução da taxa de recidiva. Objetivo: Avaliar comparativamente dois esquemas de tratamento utilizando feixes de elétrons em termos de probabilidade de cura e efeitos colaterais na área irradiada. Métodos: Estudo clínico, prospectivo, comparativo e randomizado, realizado na Faculdade de Medicina de Botucatu (Unesp), no período de 2008 a 2010, incluindo pacientes no pós-operatório imediato de ressecção de queloides, divididos nos grupos G1 e G2 que receberam tratamento radioterápico com elétrons de um Acelerador Linear, 30Gy/10 frações para G1 e 32 Gy/16 frações para G2. O seguimento foi de 18 meses. Os resultados foram avaliados através de observação feita por dois avaliadores independentes e questionário aplicado aos participantes do estudo. Resultados: Fizeram parte do estudo 43 pacientes, 21 no grupo G1 e 22 no grupo G2. No grupo G1 houve 52,4% de bons resultados e 47,6% de recidivas. No grupo G2, 91% de bons resultados e 9% de recidivas. Conclusão: O esquema 32Gy/16 frações é superior ao esquema 30Gy/10 frações, com melhor resposta terapêutica e menos efeitos colaterais.

Introduction: While several keloid treatment modalities exist, they all offer disappointing results when performed in isolation. The combination of surgical excision and post-operative irradiation with electron beams is effective in improving the quality of scars and reducing the recurrence rate of the condition. Objective: To assess, on a comparative basis, the prospects for cure, and also side effects in the irradiated areas of two treatment methods using electron beams. Methods: A prospective, comparative and randomized clinical study was carried out at the Faculdade de Medicina de Botucatu-UNESP, in Botucatu (SP), Brazil, between 2008 and 2010. The study included patients who were post-operative after their treatment for the resection of keloids. The study population was divided into groups G1 and G2, having received radiotherapy treatment with electrons from a linear accelerator at 30 Gy/10 fractions and 32 Gy/16 fractions, respectively. The patients were followed up with for 18 months. Results were assessed through the observation of two independent evaluators and the distribution of a questionnaire to study participants. Results: Forty-three patients were investigated (21 in G1 and 22 in G2). 52.4% showed good results in G1, with a recurrence rate of 47.6%. In G2, 91% showed good results, with a 9% recurrence rate. Conclusion: The 32 Gy/16 fractions method was proved to be superior to the 30 Gy/10 fractions method, resulting in a better therapeutic response and fewer side effects.

Hanseníase: diagnóstico e tratamento / Leprosy: Diagnosis and treatment

A hanseníase é infecção granulomatosa crônica causada pelo bacilo Mycobacterium leprae. É doença de altacontagiosidade e baixa morbidade. Acredita-se que a sua transmissão ocorra pelo contato íntimo e prolongado deindivíduo suscetível com paciente bacilífero, através da inalação de bacilos. A melhor forma de cessar a transmissão dadoença é diagnosticar e tratar precocemente os casos. Esta revisão da literatura visa fornecer ao profissional de saúdesubsídios que facilitem o seu desempenho no manuseio da hanseníase, contribuindo, assim, para a eliminação de fontesde infecção e prevenção de sequelas.

Implante de queratinócitos autólogos em úlceras de membros inferiores de pacientes com sequelas de hanseníase / Keratinocytes autologous implantation in lower limb ulcers of patients with leprosy sequelae

Na hanseníase as úlceras podem surgir, principalmente,pelo fato de existirem áreas anestésicas, que com facilidade podem ser traumatizadas, queimadas e secundariamente infectadas. Este estudo teve por objetivo tratar as úlceras de membro inferior de pacientes com seqüelas de hanseníase por meio do implante de queratinócitos autólogos. Participaram 14 pacientes,sendo seis com uma única úlcera, quatro com mais de uma úlcera no mesmo membro inferior e quatro com úlceras nos dois membros, totalizando 31 úlceras...

The occurrence of ulcers in leprosy is mainly due to the existence of numb areas that can easily undergo trauma and burns and there after become secondarily infected. This study aimed to treat ulcers in lower limbs of patients with leprosy sequelae through the implantation of autologous keratinocytes. The study consisted offourteen patients (six with a single ulcer, four with more than one ulcer in the same limb and four with ulcers in both limbs) with a total of 31 ulcers...

Paracoccidioidomicose em paciente com carcinoma do colo uterino / Paracoccidioidomycosis in a patient with cervical cancer

Os autores relatam caso de paciente do sexo feminino com paracoccidioidomicose, associada a carcinoma do colo uterino estádio IIIB. Paracoccidioidomicose, associada à neoplasia, ocorre entre 0,16 por cento a 14,1 por cento segundo diferentes séries de casos. Em casos com neoplasia disseminada a infecção fúngicas pode apresentar comportamento oportunístico.

This report describes the case of a female patient with paracoccidioidomycosis associated with a stage IIIB cervical carcinoma. Paracoccidioidomycosis in association with a malignant tumor occurs in 0.16 percent to 14.1 percent of cases in accordance with different case series. In cases in which the cancer is disseminated, the fungal infection may behave opportunistically.

SBD-RESP na busca ativa de casos de hanseníase / SBD-RESP in active search for leprosy cases

FUNDAMENTOS: A Sociedade Brasileira de Dermatologia Regional do Estado de São Paulo (SBD-RESP), apoiada pela Fundação Paulista Contra a Hanseníase, e em ação conjunta com os Serviços de Dermatologia do estado de São Paulo, credenciados pela Sociedade Brasileira de Dermatologia, lançou a campanha "SBD-RESP na Busca Ativa de Casos de Hanseníase". OBJETIVOS: Auxiliar o Programa Nacional de Controle da Hanseníase no controle da doença. MÉTODO: Todos os Serviços de Dermatologia do estado de São Paulo, credenciados pela Sociedade Brasileira de Dermatologia, foram convidados e os 17 que participaram receberam uma planilha de dados e modelos de materiais informativos sobre a doença. A campanha foi realizada entre os meses de maio e julho de 2010. Ao término do período, cada serviço encaminhou a planilha de dados para análise estatística. RESULTADOS: Foram examinadas 1718 pessoas e diagnosticados, no total, 90 casos de hanseníase, a maioria do gênero masculino e da cor branca, com percentuais semelhantes de multibacilares e de paucibacilares. Doze por cento apresentavam história familiar de hanseníase. O maior número de casos detectados foi na capital, seguido, no interior, pela região de Presidente Prudente. O índice de detecção em menores de 15 anos foi 4 por cento. CONCLUSÕES: Os resultados da campanha mostram a importância desta iniciativa da SBD-RESP. Sugere-se que ações semelhantes sejam repetidas e que se estendam a outras regionais da Sociedade Brasileira de Dermatologia.

BACKGROUND: The Brazilian Society of Dermatology of the State of Sao Paulo (SBD-RESP), supported by the Sao Paulo State Foundation Against Leprosy and acting jointly with Sao Paulo State Services of Dermatology, accredited by the Brazilian Society of Dermatology, launched the campaign "SBD-RESP in active search for leprosy cases". OBJECTIVES: To assist the National Leprosy Control Program in eliminating Hansen's disease. METHODS: All of the Sao Paulo State Services of Dermatology, accredited by the Brazilian Society of Dermatology, were invited to join the campaign. The 17 Services which accepted to participate received a spreadsheet of data and models of informative materials about the disease. The campaign lasted from May to July 2010. At the end of the campaign, each Service sent the spreadsheet data for statistical analysis. RESULTS: 1,718 people were examined and 90 cases of Hansen's disease were diagnosed. Most of the individuals infected were male and white and presented similar percentages of multibacillary and paucibacillary groups. Twelve percent had a family history of leprosy. The highest number of cases was detected in Sao Paulo city, followed by the region of Presidente Prudente, located in the countryside of Sao Paulo State. The detection rate in children younger than 15 years old was 4 percent. CONCLUSION: The campaign results show the importance of the SBD-RESP initiative. It is suggested that similar actions be repeated and extended to other regional offices of the Brazilian Society of Dermatology.

Estudo comparativo entre o tratamento radioterápico com elétrons e betaterapia, após cirurgia de queloides / Comparative study between the radiotherapy treatment with electrons and beta-therapy after keloid surgery

Introdução: A cirurgia de queloides, como terapêutica isolada, apresenta altos índices de recidiva, sendo necessário adicionar terapias adjuvantes. Queloides recentes são ricos em fi broblastos, que são altamente radiossensíveis, fato que explica os bons resultados da radioterapia percutânea pósoperatória. Objetivo: Comparar os resultados de betaterapia com a técnica que usa feixe de elétrons em queloides recém-operados. Material e Métodos: Delineou-se um estudo prospectivo, comparativo e randomizado, incluindo pacientes, no período pós-operatório imediato de cirurgia excisional de queloides, divididos nos grupos G1 e G2, que receberam respectivamente tratamento com placas de Sr90 (betaterapia)ou com elétrons do Acelerador Linear. O acompanhamento foi de 10 anos. A avaliação dos resultados foi realizada por meio de informações dos pacientes, parâmetros fotográfi cos, observação e mensuração das lesões, segundo os seguintes critérios: Inalterado, Regular, Bom e Ótimo. Resultados: Participaram do estudo 26 pacientes, 13 em cada grupo. No G1, 54% apresentaram critérios de melhora inalterado e regular, e 46% apresentaram os critérios bom e ótimo. No G2, esses resultados foram, respectivamente, 23% e 77%. Conclusão: A irradiação com feixe de elétrons é superior à betaterapia para o tratamento de queloides operados, devido à melhor distribuição no tecido. Não foram observados tumores radioinduzidos.

Introduction: The surgery of keloids as an individual therapy with high rates of recurrence needs adjuvant therapies as complement. Recent keloids are rich in fi broblasts, which are highly radiosensitive and what explains the good results of percutaneous radiotherapy after surgery. Objective: To compare the beta-therapy results with electron-beam technique in newly operated keloids. Material and Methods: a prospective, comparative and randomized study was outlined including patients in the immediate postoperative period of surgical excision of keloids. Divided in G1 and G2 groups respectively, they received treatment with Sr90 (beta-therapy)plates or with electrons from the linear accelerator. The monitoring lasted 10 years. The results were performed using the information from patients, photograph parameters, observation and measurement of injuries, according to the criteria: Unchanged, Regular, Good and Excellent. Results: There were 26 patients, 13 in each group. In G1, 54% presented regular and unchanged improvement criteria and 46% had good or excellent criteria. In G2, the results were respectively 23% and 77%. Conclusion: The irradiation with electron-beam is better than beta-teraphy for the treatment of keloids surgery, due to the distribution in the tissue. No radio-induced tumors were observed.

Paracoccidioidomycosis: infiltrated, sarcoid-like cutaneous lesions misinterpreted as tuberculoid leprosy / Paracoccidioidomicose: lesões cutâneas, infiltrativas, sarcoidose-símile, diagnosticadas como hanseníase tuberculóide

The authors report a case of paracoccidioidomycosis misinterpreted as tuberculoid leprosy, both on clinical and histological examination. Sarcoid-like cutaneous lesion as the initial presentation is rare in young patient with paracoccidioidomycosis and can simulate other infectious or inflammatory diseases. On histology, tuberculoid granuloma presented similar difficulties. Treatment with dapsone, a sulfonamide derivative, could have delayed the presumed natural clinical course to the classical juvenile type of paracoccidioidomycosis, observed only 24 months after the patient had been treated for leprosy.

Os Autores relatam um caso de paracoccidioidomicose diagnosticado como se fora hanseníase tuberculóide, tanto do ponto de vista clínico como histopatológico. Lesão cutânea de padrão sarcoídico é raramente observada como lesão inicial da paracoccidioidomicose em jovens e pode simular outras dermatoses infecciosas ou inflamatórias. O achado histológico de granuloma tuberculóide apresenta dificuldade diagnóstica similar. O tratamento realizado com dapsone, um derivado sulfamídico, pode ter retardado a evolução clínica esperada para o padrão clássico da paracoccidioidomicose tipo juvenil, o qual apenas se materializou 24 meses após a paciente ter iniciado tratamento como hanseníase.

Paracoccidioidomicose: freqüência, morfologia e patogênese de lesões tegumentares / Paracoccidioidomycosis: frequency, morphology, and pathogenesis of tegumentary lesions

FUNDAMENTOS: Paracoccidioidomicose é micose sistêmica de alta prevalência no Brasil. As lesões orocutâneas são de importância para o diagnóstico e acompanhamento clínico. OBJETIVO: Quantificar e qualificar a presença de lesões cutâneas em pacientes com paracoccidioidomicose e correlacionar com forma clínica e gravidade dos casos. MÉTODOS: Realizou-se estudo clínico observacional de série de casos, classificados segundo a forma clínica, localização topográfica e morfologia da lesão quando presente. RESULTADOS: Foram estudados 152 pacientes classificados como forma crônica do adulto (87,5 por cento) ou como forma aguda-subaguda, tipo juvenil (12,5 por cento). Lesão cutânea foi identificada em 61,2 por cento dos pacientes. Não houve correlação estatística entre presença de lesão e forma clínica (p=1,000) ou entre presença de lesão e gravidade clínica (p= 0,5607). Houve correlação entre presença de lesão mucosa e a forma clínica crônica do adulto (p<0,001). As lesões localizaram-se no segmento cefálico (47,6 por cento), tronco (14,9 por cento), membro superior (14,9 por cento), membro inferior (21,7 por cento) e região genital (0,7 por cento). As lesões ulceradas (42,8 por cento) e as de padrão infiltrativo (26,6 por cento dos casos), foram predominantes. CONCLUS ÃO: A freqüência de lesões cutâneas e padrão morfológico são úteis ao diagnóstico da paracoccidioidomicose. É incomum a presença de lesão da mucosa oral na forma aguda-subaguda, tipo juvenil.

BACKGROUND: Paracoccidioidomycosis is a highly prevalent systemic mycosis in Brazil. The oral and cutaneous lesions are useful for diagnostic proposals and clinical follow-up. OBJECTIVE: To quantify and qualify skin lesions associated to active paracoccidioidomycosis and to correlate them with the clinical form and severity of cases. METHODS: An observational clinical study of cases was performed. Patients were classified according to the clinical form, topographic distribution and morphology of skin lesions. RESULTS: A total of 152 patients classified as chronic form (adult type) (87.5 percent) or acute-subacute form (juvenile type) (12.5 percent) were studied. Skin lesion was diagnosed in 61.2 percent of patients. There was no statistical correlation between presence of skin lesion and clinical form (p=1.000), nor between skin lesion and severity of disease (p=0.5607). There was statistical correlation between mucosal lesion and adult patients (p <0.001). The lesions were on the cephalic segment (47.6 percent), trunk (14.9 percent), upper limbs (14.9 percent), lower limbs (21.7 percent) and genital region (0.7 percent). The ulcerated lesions (42.8 percent) and infiltrative (26.6 percent) lesions prevailed. CONCLUSION: The frequency of skin lesions and their morphology are useful for diagnosis of paracoccidioidomycosis. Oral lesions in the acute-subacute form (juvenile type) are not common.