Subject(s)
Humans , Female , Middle Aged , Skin Neoplasms/diagnosis , Skin Neoplasms/secondary , Breast Neoplasms/pathologySubject(s)
Humans , Female , Middle Aged , Foot Dermatoses/therapy , Laser Therapy , Onychomycosis/therapy , TrichophytonABSTRACT
BACKGROUND: Systemic amyloidosis is a rare disease that can affect any organ. Its clinical manifestations are varied and nonspecific. The skin involvement of this disease is common and can be easily recognized on physical examination. We report a 57-year-old male presenting with a two years history of malaise, dyspnea and myalgias. On physical examination, ungueal dystrophy, orange pigmentation of eyelids with periocular petechiae and mild macroglossia were observed. Incisional biopsies of the eyelids, cheeks and hands were obtained. The pathological study demonstrated amyloid deposits. Since protein electrophoresis was normal, the diagnosis of AA amyloidosis was postulated.
Subject(s)
Amyloidosis/pathology , Skin Diseases/pathology , Biopsy , Humans , Male , Middle AgedABSTRACT
Background: Systemic amyloidosis is a rare disease that can affect any organ. Its clinical manifestations are varied and nonspecific. The skin involvement of this disease is common and can be easily recognized on physical examination. We report a 57-year-old male presenting with a two years history of malaise, dyspnea and myalgias. On physical examination, ungueal dystrophy, orange pigmentation of eyelids with periocular petechiae and mild macroglossia were observed. Incisional biopsies of the eyelids, cheeks and hands were obtained. The pathological study demonstrated amyloid deposits. Since protein electrophoresis was normal, the diagnosis of AA amyloidosis was postulated.
Subject(s)
Humans , Male , Middle Aged , Amyloidosis/pathology , Skin Diseases/pathology , BiopsyABSTRACT
Introducción: La infección por virus papiloma humano (VPH) sería factor causal de cánceres de ano, pene, vulva y vagina. Objetivo: Analizar la evidencia actual en cuanto a infección por VPH y su rol carcinogénico en estas neoplasias. Metodología: Búsqueda de la literatura para identificar artículos sobre la transmisión sexual como factor de riesgo en cánceres anogenitales. Resultados: En lesiones premalignas y malignas anogenitales se encuentra en gran frecuencia el DNA de VPH, especialmente tipo 16. Se ha demostrado que la vacunación contra VPH previene el desarrollo de lesiones preinvasoras anales; en cambio, ni la vacuna ni la circuncisión parecen ser factores protectores contra cáncer de pene. Discusión: No hay estudios prospectivos que permitan establecer una relación causal entre VPH y cánceres anogenitales, lo que impide la elaboración de estrategias de prevención. El manejo de ciertos factores de riesgo sugeridos previamente en la literatura no reduce el riesgo de cáncer anogenital.
Introduction: Human papillomavirus (HPV) infection has been suggested as a causal factor of anal, penile, vulvar and vaginal cancers. Objective: To analyze current evidence about HPV infection and its carcinogenic role in these neoplasms. Methodology: Literature search to identify articles about sexual transmission as a risk factor in anogenital cancers. Results: In premalignant and malignant anogenital lesions, an important presence of HPV DNA is often found, specially type16. It has been demonstrated that HPV vaccine prevents premalignant anal lesions; however, this vaccine and circumcision do not seem to be protective against penile cancer. Discussion: There are no prospective studies that had established a causal relationship between HPV and anogenital cancers. This keeps off the development of adequate prevention strategies. Management of certain previously suggested risk factors do not reduce the risk of anogenital cancer.
Subject(s)
Humans , Male , Female , Vaginal Neoplasms/epidemiology , Vaginal Neoplasms/virology , Anus Neoplasms/epidemiology , Anus Neoplasms/virology , Penile Neoplasms/epidemiology , Penile Neoplasms/virology , Carcinoma/epidemiology , Carcinoma/virology , Papillomavirus Infections/complications , Vulvar Neoplasms/epidemiology , Vulvar Neoplasms/virology , Risk Factors , Sexually Transmitted DiseasesSubject(s)
Humans , Male , Adult , Atrophy/diagnosis , Atrophy/pathology , Skin Diseases/diagnosis , Skin Diseases/pathologyABSTRACT
Cutaneous tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis. It is uncommon (1% of all cases of tuberculosis), but has increased due to the human immunodeficiency virus epidemic and to pharmacologic immunosuppression. It presents a wide variety of clinical forms depending on how bacteria reach the skin and on the immune status of the patient. We present two cases of cutaneous tuberculosis diagnosed in the Hospital Clínico de la Pontificia Universidad Católica de Chile. We emphasize the difficulty in diagnosis and classification of this disease and briefly discuss on the different diagnostic and therapeutic approaches.
Subject(s)
Mycobacterium tuberculosis , Tuberculosis, Cutaneous/diagnosis , Antitubercular Agents/therapeutic use , Female , Fluorescent Antibody Technique, Direct , Humans , Middle Aged , Mycobacterium tuberculosis/genetics , Mycobacterium tuberculosis/immunology , Polymerase Chain Reaction , Tuberculosis, Cutaneous/classification , Tuberculosis, Cutaneous/pathologyABSTRACT
Syphilis is a sexually transmitted disease caused by Treponema pallidum. The diagnosis is based mainly in clinical presentation and non-specific assays. PCR-based diagnosis has been suggested as an attractive alternative method. The aim of this study was the validation of a PCR-based test for the diagnosis of early syphilis (ES) and neurosyphilis (NS). Clinical samples of mucocutaneous lesions and cerebrospinal fluid (CSF) specimens from patients previously diagnosed for ES and NS respectively using an enlarged gold standard, were tested by PCR. The reaction was done using primers targeting the tpN47gene. Twenty out of 21 mucocutaneous samples from patients diagnosed with ES were positive by PCR, with a clinical sensitivity of 95 percent. Four out of 8 CSF samples from patients previously diagnosed with NS were positive by PCR, with a clinical sensitivity of 50 percent. The clinical specificity for both ES and NS was 100 percent. The PCR sensitivity and specificity for mucocutaneous samples allowed us to implement this assay in our laboratory for routine diagnosis. Although the sensitivity of the PCR in CSF was low, it may be useful to support clinical diagnosis.
La sífilis es una enfermedad de transmisión sexual producida por Treponema pallidum, cuyo diagnóstico se realiza presuntivamente basándose en aspectos clínicos y análisis de especificidad limitada. La reacción de la polimerasa en cadena (RPC) ha sido planteada como una alternativa diagnóstica de mayor sensibilidad y especificidad. El objetivo de este trabajo fue validar una RPC para el diagnóstico de sífilis temprana (ST) y neurosífilis (NS). Se utilizaron muestras de lesiones muco-cutáneas y de LCR de pacientes con sospecha de cursar ST y NS respectivamente, previamente diagnosticados, utilizando un estándar de oro ampliado. La RPC fue realizada con partidores dirigidos al gen tpN47. De las 21 muestras de pacientes con ST, la RPC resultó positiva en 20, lo que resulta en una sensibilidad clínica de 95 por ciento. De las 8 muestras de pacientes con NS, la RPC resultó positiva en 4, obteniéndose una sensibilidad clínica de 50 por ciento. La especificidad clínica para ST y NS fue de 100 por ciento. La excelente sensibilidad y especificidad de la RPC para muestras muco-cutáneas permitió la exitosa implementación de este análisis en nuestro laboratorio para el diagnóstico de rutina. Si bien la sensibilidad de la RPC en LCR es baja, es muy útil para apoyar el diagnóstico clínico.
Subject(s)
Female , Humans , Male , DNA, Bacterial/analysis , Neurosyphilis/diagnosis , Polymerase Chain Reaction , Syphilis, Cutaneous/diagnosis , Treponema pallidum/genetics , Neurosyphilis/cerebrospinal fluid , Neurosyphilis/pathology , Prospective Studies , Sensitivity and Specificity , Syphilis, Cutaneous/cerebrospinal fluid , Syphilis, Cutaneous/pathologyABSTRACT
Cutaneous tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis. It is uncommon (1 percent of all cases of tuberculosis), but has increased due to the human immunodeficiency virus epidemic and to pharmacologic immunosuppression. It presents a wide variety of clinical forms depending on how bacteria reach the skin and on the immune status of the patient. We present two cases of cutaneous tuberculosis diagnosed in the Hospital Clínico de la Pontificia Universidad Católica de Chile. We emphasize the difficulty in diagnosis and classification of this disease and briefly discuss on the different diagnostic and therapeutic approaches.
La tuberculosis (TBC) cutánea es una enfermedad infecciosa crónica causada por Mycobacterium tubercu losis. Es una patología poco frecuente (1 por ciento de todos los casos de TBC); no obstante, ha aumentado debido a la epidemia del virus de la inmunodeficiencia humana y la presencia creciente de la inmunosupresión farmacológica. Presenta una gran variedad de formas clínicas que dependen de cómo llega el bacilo a la piel y del estado inmunológico del individuo. A continuación, presentamos dos casos clínicos de TBC cutánea vistos en el Hospital Clínico de la Pontificia Universidad Católica de Chile y una revisión del tema.
Subject(s)
Female , Humans , Middle Aged , Mycobacterium tuberculosis , Tuberculosis, Cutaneous/diagnosis , Antitubercular Agents/therapeutic use , Fluorescent Antibody Technique, Direct , Mycobacterium tuberculosis/genetics , Mycobacterium tuberculosis/immunology , Polymerase Chain Reaction , Tuberculosis, Cutaneous/classification , Tuberculosis, Cutaneous/pathologyABSTRACT
Leprosy is a granulomatous disease affecting the skin and peripheral nerves caused by Mycobacterium leprae. The range of clinical forms varying from tuberculoid to lepromatous leprosy results from variations in the cellular immune response to the mycobacterium. Despite available combined drug-therapy, it continues to be a significant public health problem, carrying a strong stigma. Although recently there has been no native cases in Chile, a few imported cases have been diagnosed. We present a 56-year-old man who had lived in Paraguay for 8 years, and presented with leprosy 6 years after returning to Chile. The biology of leprosy, clinical features of the disease, current diagnostic criteria and approaches to treatment are discussed.
Subject(s)
Leprostatic Agents/therapeutic use , Leprosy/diagnosis , Mycobacterium leprae/immunology , Clofazimine/therapeutic use , Dapsone/therapeutic use , Drug Therapy, Combination , Humans , Leprosy/drug therapy , Male , Middle Aged , Rifampin/therapeutic use , Treatment OutcomeABSTRACT
Leprosy is a granulomatous disease affecting the skin and peripheral nerves caused by Mycobcicterium leprcie. The range of clinical forms varying from tuberculoid to lepromatous leprosy results from variations in the cellular immune response to the mycobacterium. Despite available combined drug-therapy, it continues to be a significant public health problem, carrying a strong stigma. Although recently there has been no native cases in Chile, a few imported cases have been diagnosed. We present a 56-year-old man who had lived in Paraguay for 8 years, and presented with leprosy 6 years after returning to Chile. The biology of leprosy, clinical features of the disease, current diagnostic criteria and approaches to treatment are discussed.
La lepra es una enfermedad granulomatosa causada por Mycobacterium leprae, que afecta la piel y los nervios. Su espectro clínico comprende desde lepra tuberculoidea hasta la lepromatosa, siendo el resultado de las variaciones de la respuesta inmune celular a la micobacteria. A pesar de la terapia combinada, la enfermedad sigue siendo un problema de salud pública significativo y se asocia a una fuerte estigmatización. Aunque no ha habido casos autóctonos en Chile, algunos casos contraídos en el extranjero han sido diagnosticados. Se presenta un hombre de 56 años, que vivió en Paraguay durante ocho años y debutó con lepra después de seis años viviendo en Chile. Se discute la biología de la lepra, las características clínicas de la enfermedad, los criterios diagnósticos actuales y el enfoque terapéutico.
Subject(s)
Humans , Male , Middle Aged , Leprostatic Agents/therapeutic use , Leprosy/diagnosis , Mycobacterium leprae/immunology , Clofazimine/therapeutic use , Drug Therapy, Combination , Dapsone/therapeutic use , Leprosy/drug therapy , Rifampin/therapeutic use , Treatment OutcomeABSTRACT
Introducción. La luz UVB de banda angosta (nb-UVB) ha surgido como nueva propuesta para el tratamiento del prurigo nodular. Objetivo: Describir nuestra experiencia en el uso de nb-UVB para el prurigo nodular de difícil manejo. Método: Análisis retrospectivo de cinco pacientes con prurigo nodular tratados con luz nb-UVB asociado a terapia estándar. Resultados: Se obtuvo respuesta favorable en los cinco pacientes, utilizando 23,4 mas 5,6 sesiones con una dosis acumulada de 44,5 J/cm2. El promedio de remisión fue de 4,2 mas 1,6 meses. Conclusión: La terapia nb-UVB parece constituir una alternativa eficaz para el tratamiento del prurigo nodular.
Introduction. Narrow band ultraviolet B (nb-UVB) has emerged as a new proposal for treatment of nodular prurigo. Objective. To describe our experience with nb-UVB in recalcitrant nodular prurigo. Method. Retrospective analysis of five patients treated with nb-UVB associated to standard therapy Results: We obtained a favorable response in all patients with 23.4 mas: 56 sessions, using a mean accumulative dose of 44.5 J/cm2. The mean duration of remission was 42 mas: 1.6 months. Conclusion. NS-UVB phototherapy appears to be an effective treatment for recalcitrant nodular prurigo.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Middle Aged , Prurigo/radiotherapy , Ultraviolet Therapy/methods , Radiation Dosage , Phototherapy , Prurigo/pathology , Retrospective Studies , Treatment Outcome , Ultraviolet RaysABSTRACT
Mycoplasma genitalium es un patógeno oportunista del tracto genital. En el hombre es causa de uretritis, en tanto que en mujeres ha sido implicado en la etiología de cervicitis y de enfermedad inflamatoria pelviana (EIP). El objetivo de este estudio fue determinar la prevalencia de M. genitalium en pacientes masculinos con uretritis y en muestras vaginales de mujeres embarazadas. Se obtuvo muestras de secreción uretral en 37 pacientes con uretritis y de muestras vaginales de 50 consecutivas mujeres embarazadas, determinándose la presencia de M. genitalium mediante reacción de polimerasa en cadena (RPC). Las muestras de secreción uretral fueron también evaluadas en busca de Chlamydia trachomatis, Neisseria gonorrhoeae y Ureaplasma sp en tanto que en las de origen vaginal se investigó la microbiota y presencia de micoplasmas de tipo genital. Veintitrés casos fueron clasificados como uretritis no gonocóccica (UNG) y 14 como enfermedad gonocóccica. M. genitalium fue detectado en 3 de 23 (13,04 por ciento) varones con UNG; en dos casos asociado a Ureaplasma sp, y en un paciente como agente único. C. trachomatis fue detectado en 7 pacientes con UNG y en uno con gonorrea. Ureaplasma sp fue aislado en 13 (35,1 por ciento) pacientes, 8 casos de UNG y en 5 con gonorrea. El microorganismo fue detectado también en 6 (15 por ciento) de 40 mujeres; en 5 casos en presencia de microbiota normal (score de Nugent 0-3), y en un caso en presencia de vaginosis bacteriana. Ureaplasma spp fue aislado en las seis muestras positivas. En conclusión, este estudio demuestra que M. genitalium debe ser también considerado en la etiología de la UNG así como en el tracto genital inferior en la mujer embarazada, en presencia de una microbiota vaginal normal.
Subject(s)
Male , Humans , Female , Pregnancy , Genital Diseases, Female/microbiology , Genital Diseases, Male/microbiology , Mycoplasma Infections/diagnosis , Mycoplasma Infections/microbiology , Mycoplasma genitalium/isolation & purification , Chlamydia trachomatis/isolation & purification , Neisseria gonorrhoeae/isolation & purification , Polymerase Chain Reaction , Sex Factors , Bodily Secretions/microbiology , Ureaplasma/isolation & purification , Urethra , Urethritis/microbiology , VaginaABSTRACT
Mycoplasma genitalium is an opportunistic pathogen of the genital tract. It has been implicated as an etiological agent of urethritis in men and cervicitis and pelvic inflammatory disease (PID) in women. The aim of this study was to determine the prevalence of Mycoplasma genitalium in male urethritis and in vaginal specimens of pregnant women. Urethral specimens obtained from 37 men presenting with urethritis and vaginal specimens from 50 consecutive pregnant women were tested for the presence of M. genitalium by polymerase chain reaction (PCR). The urethral specimens were also examined for the presence of Neisseria gonorrhoeae, Chlamydia trachomatis and Ureaplasma sp whereas the vaginal microbiota and the presence of genital mycoplasma were investigated in the vaginal specimens. Twenty three cases were classified as nongonococcal urethritis (NGU) and 14 as gonorrheal disease. M. genitalium was detected in 3 of 23 (13.04%) men with NGU; in two cases with Ureaplasma sp, and in one patient as the unique agent. C. trachomatis was found in 7 patients with NGU and in one patient with gonorrhea. Ureaplasma sp was isolated in 13 (35.1%) patients, 8 cases of NGU and in 5 patients with gonorrhea. The organism was also detected in 6 (15%) of 40 women; in 5 cases in the presence of a normal microbiota (Nugent score 0-3), and an in one case in the presence of bacterial vaginosis. Ureaplasma spp was isolated in the 6 positive specimens. This study indicates that M. genitalium can be detected in urethral specimens of some cases of NGU as well as in the lower genital tract of pregnant women in the presence of a normal vaginal microbiota.
Subject(s)
DNA, Bacterial/isolation & purification , Mycoplasma Infections/microbiology , Mycoplasma genitalium/isolation & purification , Urethritis/microbiology , Vagina/microbiology , Chile , DNA, Bacterial/genetics , Female , Humans , Male , Mycoplasma genitalium/genetics , Polymerase Chain Reaction , PregnancyABSTRACT
La epidemia de VIH ha modificado dramáticamente el campo de las enfermedades de transmisión sexual. La infección por VIH es única dentro de las enfermedades de transmisión sexual, porque puede modificar la presentación clínica y las características de otras enfermedades de transmisión sexual. A su vez, otras enfermedades de transmisión sexual pueden afectar la transmisión de VIH. Este artículo revisa las principales enfermedades de transmisión sexual que afectan a los pacientes VIH, su epidemiología y recomendaciones para la detección, seguimiento y tratamiento.
Subject(s)
Humans , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/therapy , HIV Infections/diagnosis , HIV Infections/therapy , Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/therapy , Diagnosis, Differential , Gonorrhea , Herpes Genitalis/complications , Herpes Genitalis/therapy , HIV Infections/epidemiology , Neurosyphilis , Syphilis/diagnosis , Acquired Immunodeficiency Syndrome/epidemiology , Signs and SymptomsABSTRACT
The yeast Malassezia spp has an established etiological role in pityriasis versicolor, folliculitis, systemic infections and onychomycosis. Aim: To assess the presence of Malassezia spp in patients with seborrheic dermatitis (SD), to find a correlation between Malassezia spp count and the severity of the disease and to compare the prevalence of the different Malassezia species in SD patients and subjects without skin lesions. Patients and methods: Scrapings of the face from 81 patients with SD (69 males) and 79 subjects (54 males) without skin lesions were obtained for a direct microscope examination and yeast culture. Results: The yeast Malassezia was found in 76% of SD patients and in 82% of subjects without skin lesions. There was a positive correlation between the number of yeasts found on direct examination and the clinical severity of lesions in SD patients. Although this correlation was statistically significant (p=0.046), the degree of association (rho=0.22) was weak. Fifty Malassezia species were identified. M globosa was found in 67% of SD patients, followed by M furfur and M sympodialis, each present in 16.5% of the SD patients. In subjects without skin lesions, the most prevalent species were M globosa (77%), followed by M sympodialis (12%), M slooffiae (7%) and M furfur (4%). Conclusions: The presence of the yeast Malassezia is not associated with the presence of skin lesions (Rev Méd Chile 2003; 131: 1295-300).