Síndrome de úlceras en piernas de carácter familiar y comienzo precoz / Familial Leg Ulcer Syndrome of Early Onset

Introducción: Las úlceras en las piernas son llagas sin sanar o lesiones abiertas de etiología multifactorial. Constituyen una patología importante en la práctica diaria de los profesionales de la salud en todos los niveles de asistencia. Objetivo: Presentar un caso infrecuente con una afección genética hereditaria familiar que provocó lesiones ulcerosas en las extremidades inferiores. Presentación del caso: Paciente masculino de 30 años con lesiones ulcerosas en ambos miembros inferiores, de 18 años de años de evolución, muy dolorosas con signos de infección local severa. Presentó diagnóstico de úlceras inespecíficas en ambos miembros inferiores. Fue ingresado con toma de su estado general, gran limitación de la deambulación, dolor intenso en ambas piernas, lesiones abundantes ulcerosas sucias diseminadas en ambas piernas, de fondo amarillento, con secreción amarilla clara, muy fétida. Se realizó estudio clínico, humoral, imagenológico, microbiológico y anátomo-histopatológico. Conclusiones: Se diagnostica síndrome de úlceras en piernas de carácter familiar y comienzo precoz, de herencia recesiva ligada al cromosoma X. Se requieren estudios a mayor escala para evaluar las contribuciones de los factores genéticos en la génesis de esta enfermedad, los cuales podrían ser la clave para comprender mejor su desarrollo(AU)

Introduction: Leg ulcers are unhealed sores or open lesions of multifactorial etiology. They constitute an important pathology in the daily practice of health professionals at all levels of care. Objective: To report an infrequent case with a familial hereditary genetic condition that caused ulcerative lesions in the lower limbs. Case report: We report the case of a 30-year-old male patient with ulcerative lesions on both lower limbs, 18 years of evolution, very painful with signs of severe local infection. He had diagnosis of nonspecific ulcers in both lower limbs. He was admitted with poor general condition, great limitation of ambulation, intense pain in both legs, abundant dirty yellowish ulcerative lesions scattered on both legs, and light yellow, very foul-smelling discharge. A clinical, humoral, imaging, microbiological and anatomical-histopathological study was performed. Conclusions: The diagnosis was familial leg ulcer syndrome of early onset, recessive inheritance linked to the X chromosome, is diagnosed. Larger scale studies are required to assess the contributions of genetic factors in the genesis of this disease, which could be the key to better understand its development(AU)

Phenotypic, molecular and antimicrobial susceptibility assessment in isolates from chronic ulcers of cured leprosy patients: a case study in Southern Brazil

BACKGROUND: One of the most stigmatizing physical sequelaeof leprosy in cured patients is the development of chronic lower extremity ulcers. The bacterial diversity present in ulcers is considered one of the factors that can delay the healing process, as well as serve as a focus for severe secondary infections. OBJECTIVE: To identify the microbiota and antimicrobial resistance profile of bacteria isolated from skin ulcers in patients cured of leprosy. METHODS: After obtaining informed consent, material was collected from ulcers of 16 patients treated at the Outpatient Public Health Dermatology Clinic of Rio Grande do Sul and Hospital Colônia Itapuã. Sampleswere collected during dressing, and the material sent to the Microbiology Laboratory of the Federal University of Health Sciences of Porto Alegre for microbiological culture. Methicillin-resistant Staphylococcus aureus (MRSA) was characterized by two molecular methods, including detection of the mecA gene by PCR and SCCmecgene typing. RESULTS: Cultures revealed microorganisms in all ulcers: Gram-negative bacilli in 80%, Gram-positive cocci in 63%, and mixed microflora in 36%. Staphylococcus aureus and Pseudomonas aeruginosa were the most prevalent bacteria. Assessment of the antimicrobial resistance profile was notable for the presence of MRSA. Molecular analysis of this isolate revealed presence of the mecA gene contained in a type IV staphylococcal cassette chromosome mec (SCCmec). CONCLUSIONS: In patients with leprosy, laboratory culture of skin ulcers is essential for correct antibiotic selection and to control emerging pathogens, such as MRSA carrying SCCmec type IV. .

First detection of Corynebacterium ulcerans producing a diphtheria-like toxin in a case of human with pulmonary infection in the Rio de Janeiro metropolitan area, Brazil

The frequency and severity of human infections associated with Corynebacterium ulcerans appear to be increasing in different countries. Here, we describe the first C. ulcerans strain producing a diphtheria-like toxin isolated from an elderly woman with a fatal pulmonary infection and a history of leg skin ulcers in the Rio de Janeiro metropolitan area.

O uso do laser de ingap (670nm) na cicatrização de úlceras de perna em pacientes com anemia falciforme / InGaP (670nm) laser use in the leg ulcer healing in patients with sicklecell anemia

Tendo em vista que, as úlceras de perna da doença falciforme são de difícil cicatrização e, baseado nas repostas positivas obtidas com o uso da radiação laser de baixa intensidade em feridas cutâneas, este estudo teve como objetivo observar o efeito do laser de InGaP (670 nm, 6mW, vermelho, contínuo) na cicatrização dessas úlceras e no alívio da dor. A amostra foi constituída de seis pacientes portadores de anemia falciforme, com úlcera de perna, divididos igualmente em dois grupos: A (experimental) e B (controle). Os dois grupos seguiram o mesmo protocolo de curativo, sendo que, o grupo A, foi submetido à radiação laser de InGaP (3 J/cm2 , três vezes por semana, durante três meses). A análise estatística, comparando os dois grupos, mostrou uma diferença significativa na redução da área da úlcera do grupo experimental através do teste de Mann-Whitney (p = 0,014) e uma tendência linear decrescente (c2 = 0,52; p = 0,770761) através do teste Qui-quadrado de tendência. O teste Komogorov – Smirnov mostrou uma diferença significativa (p = 0,034) na redução da dor. Os resultados evidenciaram que o grupo experimental obteve maior redução da área da úlcera, maior formação de tecido de granulação, e maior alívio da dor.

Chronic ulcers and myasis as ports of entry for Clostridium tetani

Evaluating tetanus immune status is not yet the usual clinical practice regarding patients with chronic ulcers or myasis. However, of 858 tetanus patients at Hospital Couto Maia (Salvador, Bahia, Brazil) aged 1 year or above, 2 had pressure ulcers and 17 had chronic ulceration of the lower limbs where these skin lesions were the ports of entry for Clostridium tetani. In these 19 cases, the following predisposing factors were described: venous insufficiency (n=6), sickle cell anemia (n=2), Hansen s disease (n=1), malnutrition (n=1), diabetes mellitus (n=1), trauma (n=1) and unknown factors (n=7). In 6 other cases, in addition to the Hansen s disease patient, the port of entry for tetanus was the site of extraction of Tunga penetrans larvae. In these 25 cases, the majority of patients (68) were over 40 years old (17/25) and all of these patients stated that they had either not followed a tetanus toxoid vaccination regimen (19/25), or had partially completed such a regimen, or did not give precise information (6/25). Among the same series studied, over half (52) of the patients died (13/25). We conclude that tetanus prevention must be included in the treatment of chronic skin ulcer patients, vaccination coverage should be increased among older people, and strategies aimed at improving coverage for all age groups must be reviewed.

Tratamento de feridas crônicas com coberturas oclusivas: alteraçäo qualitativa da microbiota / The treatment of chronic wounds with occlusive dressing: alteration in the microbiota

Trata-se de um estudo exploratório e prospectivo, desenvolvido junto a pacientes portadores de ferida em membros inferiores. Teve como objetivo geral analisar a microbiota de feridas crônicas em membros inferiores...

Uncommon manifestations of opportunistic infections in an HIV infected patient.

A case of an HIV infected patient complicated with Penicillium marneffei and Rhodococcus equi infection is reported. He presented with chronic ulcer as pyoderma gangrenosum-like on his right calf and submandibular lymphadenitis as scrofuloderma-like. Penicillium marneffei and Rhodococcus equi were isolated from the ulcer and lymph node respectively.

Estudio micológico en 150 pacientes con úlceras de estasis / Mycological study in 150 patients with stases ulcer

Se realiza un estudio micológico en 150 úlceras de estasis. Cuarenta lesiones presentaron crecimiento de hongos patógenos del género Candida. Las especies Candida aisladas fueron: Albicans, Parakrusei, Guillermondi, Krusei y Tropicalis. Las úlceras posflebíticas fueron las más afectadas por hongos. Señala la frecuente asociación de los hongos a microorganismos bacterianos. Algunos de los factores que presentan las úlceras de estasis son favorecedores de las micosis