Diversidade clínica e tratamento da leishmaniose visceral / Clinical diversity and treatment of visceral leishmaniasis

A leishmaniose visceral (LV) é causada por protozoários do gênero Leishmania, sendo as duas principais espécies: Leismania (Leishmania) donovani e Leishmania (Leishmania) infantum, as quais tem ocorrência geográfica diversa e estão relacionadas com diversidade de manifestações clinicas e de resposta terapêutica. Notadamente, a LV que ocorre, principalmente, na Índia Sudão, Sudão do Sul, Bangladesh e Etiópia é causada pela espécie L. donovani, enquanto nas Américas e em algumas regiões da África e Europa, a espécie causadora é a L. infantum. A LV causada pela L. (L.) donovani tem um espectro clínico variando de comprometimento visceral à lesão cutânea que ocorre após um episódio de LV, que é a leishmaniose dérmica póskalazar (PKDL), manifestações esta que não é muito frequente na LV causada pela L. infantum. Ademais, a resposta terapêutica é divergente entre essas espécies, visto que na LV causada por L. donovani há pobre resposta ao antimonial pentavalente, configurando um padrão de resistência elevado, enquanto que na LV causada pela L. infantum essa informação não é muito clara. Neste artigo abordamos a diversidade clínica e a resposta terapêutica da LV causada principalmente por L. infantum, que é de ocorrência nas Américas.

Visceral leishmaniasis (VL) is caused by protozoa of the genus Leishmania, of the species Leismania (Leishmania) donovani and Leishmania (Leishmania) infantum, which occur in different geographic regions and are related to the diversity of clinical manifestations and therapeutic response. Notably, VL occurring mainly in India, Sudan, South Sudan, Bangladesh and Ethiopia is caused by L. donovani, while in the Americas and in some regions of Africa and Europe is caused by L. infantum. Visceral leishmaniasis caused by L. donovani has a clinical spectrum ranging from visceral involvement to cutaneous lesion that occurs after a VL episode, which is post-kala-azar-dermal-leishmaniasis (PKDL), which is not very frequent in the VL caused by L. infantum. In addition, the therapeutic response is divergent among these species, since in VL caused by L. donovani there is poor response to pentavalent antimony, setting a high resistance pattern, whereas in VL caused by L. infantum this information is not very clear. In this article, we discuss the clinical diversity and therapeutic response of VL caused mainly by L. infantum, which is occurring in the Americas.

Clinical Diversity of Atopic Dermatitis: A Review of 5,000 Patients at a Single Institute

PURPOSE: Atopic dermatitis (AD) is a chronic eczematous dermatitis that has a high prevalence and diverse clinical features. Although several hypotheses about its multifactorial pathogenesis have been suggested, the cause is not yet fully understood. A better understanding of the clinical features may helpful inelucidating the pathogenesis of AD. METHODS: This retrospective study analyzed the questionnaires, medical charts, and laboratory examination results of 5,000 patients diagnosed with AD at a single tertiary hospital in Korea. RESULTS: The demographics, allergic comorbidities, family history, severity, and treatment experiences of the patients were analyzed. Most of the patients were adults, 76.3% of whom were classified as havingan extrinsic type of AD. The mean eczema area and severity index (EASI) score was found to be 13.68, and adult patients were found to have higher severity than the other age groups. The anatomical involvements were different among the age groups, with more involvements of the head and neck in adults. The patients reported seasonal changes and stress as the factors that aggravated their symptoms the most. Topical steroids and oral cyclosporine were the most used medications at our clinic, whereas 10.1% of the patients underwent allergen-specific immunotherapy. CONCLUSION: This analysis of 5,000 patients would lead to a better understanding of various subtypes and diverse clinical features of AD in Koreans. Distinct characteristics were observed among different age groups; thus, treatment strategies may need to be differentiated accordingly.

Clinical Diversity of Struma Ovarii / 대한산부인과학회잡지

Struma ovarii is a rare tumor of the ovary pathologically resembling teratomas with thyroid components. The presenting clinical, radiological, and pathological features of patie-nts with consequent struma ovarii is diverse and does not give substantial information with regard to the nature of the ovarian tumor. Ten cases collected over a period of eight years from two institutes are presented which showed a wide diversity of clinical features, and in which the diagnosis was only made later by strict pathological criteria. The treatment for struma ovarii, and in even rarer cases, malignant struma ovarii, remains highly controvers-ial, but it is suggested that conservative treatment by tumor excision only may be sufficie-nt. Surgical treatment also greatly ameliorates any accompanying hydrothorax and ascites.