Rhinosporidiosis: the largest case series in Brazil

Abstract: INTRODUCTION: Rhinosporidiosis is a chronic infection of the mucous membrane and is caused by Rhinosporidium seeberi, an aquatic mesomycetozoan. The mode of infection is probably transepithelial penetration. The large number of rivers and lakes and the strong presence of riparian populations in the State of Maranhão are strong predisposing factors for rhinosporidiosis. METHODS: A 5-year retrospective study was conducted in a tertiary medical center situated in Maranhão, Northeast Brazil. Twenty-five Maranhense patients diagnosed with rhinosporidiosis were analyzed. RESULTS: Most of the patients were children, adolescents and young adults (age range: 7-24 years, mean age: 14 years). The majority of the participants were male (84%), brown (76%), and students (92%). All lesions involved the entire nasal cavity and presented with a vascular polypoid mass. All patients were treated by surgical excision of the lesions. CONCLUSIONS: Rhinosporidiosis affects younger age groups, especially students from the countryside and the outskirts of urban areas. This study will aid and guide physicians in diagnosing and treating this infection in endemic areas.

Remodelamento das pequenas vias aéreas nas pneumonias intersticiais idiopáticas / Aspects of psychosexuality and personality of maleto- female and female-to-male transsexuals evaluated by Szondi projetive test

Introdução: Poucos estudos têm sido direcionados às mudanças histopatológicas nas pequenas vias áreas e seu possível papel no processo de remodelamento, nas pneumonias intersticiais idiopáticas. Objetivos: Estudar aspectos morfológicos, morfométricos e de imunohistoquímica das pequenas via aéreas na Fibrose Pulmonar Idiopática/ Pneumonia Intersticial Usual (FPI/ UIP) e Pneumonia Intersticial Não-específica (NSIP). Métodos: Foram estudadas as pequenas vias aéreas em biópsias pulmonares de 29 pacientes com FPI/ UIP e 08 com NSIP. As biópsias foram comparadas com 13 pacientes com Bronquiolite Constritiva Crônica (BC) - como controle positivo - e 10 pulmões controles normais de autópsia. Foram analisados semi e quantitativamente aspectos arquiteturais, inflamatórios, estruturais das vias aéreas, além da expressão de TGF-β, MMP -2, -7, -9, e seus inibidores (TIMP-1, -2). Resultados: Comparados com os controles, pacientes com FPI/ UIP, NSIP e BC apresentaram inflamação bronquiolar, inflamação e fibrose peribronquiolar aumentadas e áreas luminais diminuídas. Pacientes com FPI/ UIP tiveram paredes das vias aéreas mais espessadas, devido ao aumento de todos os compartimentos. Pacientes com NSIP apresentaram área do epitélio aumentada, enquanto pacientes com BC tiveram maior lâmina própria. Todos os grupos estudados demonstraram expressão epitelial bronquiolar aumentada de MMP-7 e -9 comparados ao controle. Conclusão: As pequenas vias aéreas são patologicamente alteradas e podem fazer parte do processo de remodelamento nas pneumonias intersticiais idiopáticas.

Background: Few studies have addressed small airway (SA) histopathological changes, and their possible role in the remodeling process, in idiopathic interstitial pneumonias. Objectives: To study morphological, morphometrical and immunohistochemical features of SA in Idiopathic Pulmonary Fibrosis (Usual Interstitial Pneumonia - UIP) and Non-Specific Interstitial Pneumonia (NSIP). Methods: We analyzed SA pathology in lung biopsies of 29 patients with UIP and of 8 with NSIP. Biopsies were compared with lung tissue of 13 patients with Constrictive Bronchiolitis (CB) - as a positive control - and 10 normal autopsied control lungs. We analyzed, semi-quantitatively, SA structure, inflammation, architectural features and the bronchiolar epithelial immunohistochemical expression of TGF-β, MMP -2, -7, -9, and their tissue inhibitors (TIMP-1, -2). Results: Compared to controls, patients with UIP, NSIP and CB presented increased bronchiolar inflammation, peribronchiolar inflammation and fibrosis and decreased luminal areas. UIP patients had thicker walls, due to an increase in most airway compartments. NSIP patients presented increased epithelial areas, whereas patients with CB had larger inner wall areas. All of the groups studied presented increased bronchiolar expression of MMP-7 and MMP-9, compared to the controls. Conclusion: We conclude that SA are pathologically altered and may take part in the lung remodeling process in idiopathic interstitial pneumonias.

Espondilodiscite por brucelose: relato de caso / Brucellosis spondylodiscitis: case report

Relata-se um caso de espondilodiscite por Brucella em um paciente do sexo masculino, 56 anos, fazendeiro, com manifestações sistêmicas da doença. O diagnóstico foi realizado por sorologia com título de 1/160, hemocultura positiva, o VHS foi elevado, bem como alterações radiológicas mostraram espondilodiscite ao nível de T8/T9 compatíveis com a patologia. O paciente foi tratado com estreptomicina 1gIM/dia por 15 dias, doxaciclina e rifampicina por seis semanas, com melhora clínica do quadro. O envolvimento vertebral na brucelose é uma complicação de ocorrência variável na literatura, mas considerado pouco freqüente, de difícil diagnóstico principalmente em regiões com alta prevalência de tuberculose, visto que esta pode mimetizar o quadro de brucelose. Chama-se atenção a um caso raro de espondilodiscite por brucelose, dada a necessidade de diagnóstico precoce e tratamento a fim de se evitar possíveis seqüelas.

A case of spondylodiscitis due to Brucella with systematic manifestation of the disease, in a 56-year-old male patient who was a farmer, is reported. The diagnosis was made from serological tests, with a titer of 1/160. The blood culture was positive and the blood sedimentation rate was high. Radiological abnormalities showed spondylodiscitis at the T8/T9 level that were compatible with this disease. The patient was treated with streptomycin at 1g IM/day for 15 days, and doxycycline plus rifampicin for six weeks, with a clinical improvement in the condition. Vertebral involvement in brucellosis is a complication of variable occurrence in the literature. However, it is considered to be infrequent and difficult to diagnose, particularly in regions with high prevalence of tuberculosis, given that this may mimic conditions of brucellosis. Attention is drawn to this rare case of spondylodiscitis due to brucellosis, given the need for early diagnosis and treatment in order to avoid possible sequelae.