Chronic polyarthritis as isolated manifestation of toxocariasis / Poliartrite crônica como manifestação isolada da toxocaríase

ABSTRACT Human toxocariasis is a parasitic zoonosis mainly caused by Toxocara canis or Toxocara catiand is acquired by ingestion of the parasite’s embryonated eggs. Arthralgia and/or arthri-tis were reported in up to 17% of the cases, generally with acute duration (less than 6weeks). However, to our knowledge, chronic polyarthritis, as the isolated presentation ofToxocara infection, was not reported. One of the 5809 patients that was followed up at ourservice (0.017%) had chronic polyarthritis as the single manifestation of toxocariasis and wasdescribed herein. A 3-year-old girl was referred to our service with severe painful chronicpolyarthritis for a period longer than 10 weeks and morning stiffness of 30 min. Dog contactexposure history in the recreational areas of neighborhood was reported. Her exams showedhigh levels of eosinophils in peripheral blood (29%), bone marrow aspirate revealed markedeosinophilia (32%) and Toxocara enzyme-linked immunosorbent assay (Elisa) was positive(1:1280). She was treated with paracetamol (40 mg/kg/day) and thiabendazole (25 mg/kg/day)for 10 days, and all manifestations reduced. After eight months of follow-up, she was onclinical and laboratorial remission. In conclusion, we described a case of chronic polyarthri-tis, as isolated manifestation of toxocariasis, mimicking juvenile idiopathic arthritis andleukemia. Importantly, this zoonosis should be considered in patients with arthritis andeosinophilia.

RESUMO A toxocaríase é uma zoonose parasitária causada principalmente pelo Toxocara canis ou peloT. cati. É adquirida pela ingestão de ovos embrionados do parasita. A artralgia e/ou artriteforam relatadas em até 17% dos casos, geralmente com duração aguda (menos de seis sema-nas). No entanto, que se tem conhecimento, a poliartrite crônica como manifestação isoladada infecção por Toxocara ainda não foi descrita na literatura. Um dos 5.809 pacientes acom-panhados em nosso serviço (0,017%) exibiu poliartrite crônica como manifestação únicada toxocaríase e foi descrito neste estudo. Uma menina de três anos foi encaminhada aonosso serviço com poliartrite crônica dolorosa grave por um período superior a 10 semanase rigidez matinal diária de 30 minutos. Foi relatada história de exposição a contato comcão nas áreas de lazer do bairro. Seus exames revelaram níveis elevados de eosinófilos nosangue periférico (29%), o aspirado de medula óssea revelou eosinofilia acentuada (32%)e o ensaio imunoenzimático ligado a enzima (ELISA) para Toxocara foi positivo (1:1.280). Acriança foi tratada com paracetamol (40 mg/kg/dia) e tiabendazol (25 mg/kg/dia) durante10 dias e houve regressão de todas as manifestações. Depois de oito meses de seguimento,a pequena paciente estava em remissão clínica e laboratorial. Em conclusão, descreve-seum caso de poliartrite crônica como manifestação isolada da toxocaríase, que mimetizouuma artrite idiopática juvenil e leucemia. É importante ressaltar que essa zoonose deve serconsiderada em pacientes com artrite e eosinofilia.

A rare case of disseminated cysticercosis: Case report and literature review.

Cysticercosis is a common tropical disease. One of the uncommon manifestations of cysticercosis and a rare complication is its disseminated form. We report an immunocompetent patient with disseminated cysticercosis who had involvement of the brain, subcutaneous tissues, lungs and skeletal muscles and presented with arthritis. He was otherwise asymptomatic in spite of the extensive involvement of multiple organs. A planned approach to therapy is necessary to prevent complications.

Study of gamma-interferon in schhistosomiasis mansoni, autoimmune diseases and schistosomal arthhropathy

IFN-gamma, aTh1 cytokine, was quantitatively estimated using EASIA in the sera of patients with different stages of Schistosomiasis mansoni autoimmune diseases and schistosomal arthropathy. Level of IFN-gamma was significantly elevated in all the test groups compared to the control group. The highest level of IFN-gamma observed was in RA and SLE with insignificant statistical difference between them. Cases with early S. mansoni infection showed significant higher level of IFN-gamma compared to hepatosplenic schistosomiasis with and without ascites. A significant statistical difference concerning IFN-gamma level was observed when comparing RA and SLE to different stages of S. mansoni infection and schistosomal arthropathy. This study concluded that IFN-gamma estimation in sera of patients having joint complaint could be a good marker for differentiation between autoimmune collagen induced arthritis and schistosomiasis induced arthropathy

"Pararamose": an occupational arthritis caused by lepidoptera (Premolis semirufa): an epidemiological study

The frequency of "pararama" occupational accidents between 1988 and 1990 as well as some associated clinical manifestations are herein reported. Data were collected at an industrial rubber tree plantation, in the northern part of Brazil and compared with data similarly collected from 1971 to 1974 on the same plantation, before starting protective measures. "Pararama" is the popular name of the larval form of a native insect of the Amazonian region, Premolis semirufa. During the study period, the annual average of latex extractors was 337 and 60 accidents caused by "pararama" were registered. The annual average number of accidentes per worker from 1971 to 1974 was 0.117 and in the period of this study, 0.063(p=0.061). Nineteen injured subjects were clinically evaluated and 13 of them were symptomic. There was a statistically significant association between multiple accidents and the presence of symptoms (p=0.001). "Pararamose", an occupational arthropathy, which may evolve with functional impairment of the affected joint, can be prevented with the latex extractors education and the institution of prophylactic measures, such as the use of gloves, boots and protective glasses