Actinic prurigo.

Actinic prurigo is a chronic photodermatosis with onset in childhood or before 20 years of age. It is most prevalent in Amerindians and Latin American mestizos, although it has been reported worldwide. Patients present with photodistributed, erythematous excoriated papules, cheilitis, and conjunctivitis. There is strong association with human leukocyte antigen DR4, especially the DRB1*0407 subtype. Treatment consists of photoprotection and the use of thalidomide.

Miltefosine and antimonial drug susceptibility of Leishmania Viannia species and populations in regions of high transmission in Colombia.

BACKGROUND: Pentavalent antimonials have been the first line treatment for dermal leishmaniasis in Colombia for over 30 years. Miltefosine is administered as second line treatment since 2005. The susceptibility of circulating populations of Leishmania to these drugs is unknown despite clinical evidence supporting the emergence of resistance. METHODOLOGY/PRINCIPAL FINDINGS: In vitro susceptibility was determined for intracellular amastigotes of 245 clinical strains of the most prevalent Leishmania Viannia species in Colombia to miltefosine (HePC) and/or meglumine antimoniate (Sb(V)); 163, (80%) were evaluated for both drugs. Additionally, susceptibility to Sb(V) was examined in two cohorts of 85 L. V. panamensis strains isolated between 1980-1989 and 2000-2009 in the municipality of Tumaco. Susceptibility to each drug differed among strains of the same species and between species. Whereas 68% of L. V. braziliensis strains presented in vitro resistance to HePC, 69% were sensitive to Sb(V). Resistance to HePC and Sb(V) occurred respectively, in 20% y 21% of L. panamensis strains. Only 3% of L. V. guyanensis were resistant to HePC, and none to Sb(V). Drug susceptibility differed between geographic regions and time periods. Subpopulations having disparate susceptibility to Sb(V) were discerned among L. V. panamensis strains isolated during 1980-1990 in Tumaco where resistant strains belonged to zymodeme 2.3, and sensitive strains to zymodeme 2.2. CONCLUSIONS/SIGNIFICANCE: Large scale evaluation of clinical strains of Leishmania Viannia species demonstrated species, population, geographic, and epidemiologic differences in susceptibility to meglumine antimoniate and miltefosine, and provided baseline information for monitoring susceptibility to these drugs. Sensitive and resistant clinical strains within each species, and zymodeme as a proxy marker of antimony susceptibility for L. V. panamensis, will be useful in deciphering factors involved in susceptibility and the distribution of sensitive and resistant populations.

Perforation of the nasal septum as the first sign of histoplasmosis associated with AIDS and review of published literature.

Disseminated histoplasmosis in South America is associated with AIDS in 70-90 % of cases. It is visceral and cutaneous, compromising the oral, pharynx, and laryngeal mucous membranes. The involvement of the nasal mucosa is unusual. Two patients with perforation of the nasal septum as the only sign of their disease were clinically and histopathologically diagnosed as leishmaniasis. The revision of the biopsies and the culture of nasal discharge secretions showed that the pathogens seen were not amastigotes but Histoplasma capsulatum. Other mycotic lesions were not detected, nor there was history of cutaneous leishmaniasis. The leishmanin skin test, available only for the male patient, was negative. The PCR and immunofluorescence antibody titers for Leishmania were negative in both patients. They were HIV positive; in the male, his CD4+ T cell count was 60/mm(3) and in the female 133/mm(3). The nasal ulcer was the only manifestation of histoplasmosis and the first of AIDS in both patients. The male patient recovered with amphotericin B and itraconazole treatment. The female has improved with itraconazole. Both patients received antiretroviral treatment. Nasal mucous membrane ulcers should include histoplasmosis among the differential diagnosis. In conclusion, two patients had perforation of their nasal septum as the only manifestation of histoplasmosis, a diagnosis confirmed by nasal mucosa biopsy and by culture of H. capsulatum, findings which demonstrated that both patients had AIDS.

[Delay in leprosy diagnosis as a predictor of disability in a cohort of patients in Colombia, 2000-2010]. / Retraso en el diagnóstico de lepra como factor pronóstico de discapacidad en una cohorte de pacientes en Colombia, 2000-2010.

OBJECTIVE: Evaluate predictive factors of disability at time of leprosy diagnosis in a cohort of Colombian patients, from 2000 to 2010. METHODS: Descriptive and analytical observational study of a retrospective cohort of patients admitted with a leprosy diagnosis to the Centro Dermatológico Federico Lleras Acosta in Bogotá, Colombia, from 2000 to 2010. Variables were analyzed descriptively and predictive factors for disability at diagnosis were identified through simple and multifactorial analyses (Cox proportional hazards model); hazard ratios for each factor in the model were calculated. RESULTS: Time between first symptoms and diagnosis in the 333 cohort patients was 2.9 years on average; 32.3% had certain degree of disability, especially for the feet. Delay in diagnosis and disability was greater in men than in women and in patients with multibacillary rather than paucibacillary leprosy. Disability was significantly associated with delays of ≥ 1 year in diagnosis, age ≥ 30 years, initial bacillary index of ≥ 2, multibacillary leprosy, and natives of the Cundinamarca or Santander departments. Protective factors were female sex, having some education, and residence in Boyacá. CONCLUSIONS: Time between first symptoms and diagnosis is the key predictive factor of disability at time of leprosy diagnosis. Strengthening of active searching for infected people and promotion of early diagnosis are recommended.

Retraso en el diagnóstico de lepra como factor pronóstico de discapacidad en una cohorte de pacientes en Colombia, 2000 - 2010 / Delay in leprosy diagnosis as a predictor of disability in a cohort of patients in Colombia, 2000 - 2010

OBJETIVO: Evaluar los factores pronósticos de la presencia de discapacidad al momento del diagnóstico de lepra en una cohorte de pacientes colombianos de 2000 a 2010. MÉTODOS: Estudio analítico y observacional descriptivo de una cohorte retrospectiva de pacientes ingresados con diagnóstico de lepra en el Centro Dermatológico Federico Lleras Acosta, de Bogotá, Colombia, entre 2000 y 2010. Se realizó el análisis descriptivo de las variables y se identificaron factores pronósticos de la presencia de discapacidad al momento del diagnóstico mediante análisis simple y multifactorial (modelo de riesgos proporcionales de Cox); se calcularon las razones de riesgo (hazard ratio) para cada uno de los factores incluidos en el modelo. RESULTADOS: El tiempo entre los primeros síntomas y el diagnóstico en los 333 pacientes de la cohorte fue en promedio 2,9 años; 32,3% de ellos tenían algún grado de discapacidad, especialmente en los pies. Hubo una mayor proporción de retraso en el diagnóstico y discapacidad en hombres que en mujeres y en pacientes con lepra multibacilar que con paucibacilar. La discapacidad se asoció significativamente con demoras ≥ 1 año en el diagnóstico, edad ≥ 30 años, índice baciloscópico inicial ≥ 2, lepra multibacilar y proceder de Cundinamarca o Santander. Los factores protectores fueron ser del sexo femenino, tener algún grado de escolaridad y residir en Boyacá. CONCLUSIONES: El tiempo entre los primeros síntomas y el diagnóstico constituye el factor pronóstico clave de la discapacidad al momento del diagnóstico de lepra. Se recomienda reforzar la búsqueda activa de personas infectadas y promover el diagnóstico precoz.

OBJECTIVE: Evaluate predictive factors of disability at time of leprosy diagnosis in a cohort of Colombian patients, from 2000 to 2010. METHODS: Descriptive and analytical observational study of a retrospective cohort of patients admitted with a leprosy diagnosis to the Centro Dermatológico Federico Lleras Acosta in Bogotá, Colombia, from 2000 to 2010. Variables were analyzed descriptively and predictive factors for disability at diagnosis were identified through simple and multifactorial analyses (Cox proportional hazards model); hazard ratios for each factor in the model were calculated. RESULTS: Time between first symptoms and diagnosis in the 333 cohort patients was 2.9 years on average; 32.3% had certain degree of disability, especially for the feet. Delay in diagnosis and disability was greater in men than in women and in patients with multibacillary rather than paucibacillary leprosy. Disability was significantly associated with delays of ≥ 1 year in diagnosis, age ≥ 30 years, initial bacillary index of ≥ 2, multibacillary leprosy, and natives of the Cundinamarca or Santander departments. Protective factors were female sex, having some education, and residence in Boyacá. CONCLUSIONS: Time between first symptoms and diagnosis is the key predictive factor of disability at time of leprosy diagnosis. Strengthening of active searching for infected people and promotion of early diagnosis are recommended.

Manifestaciones Dermatológicas del SIDA

En los pacientes con Sindrome de Inmunodeficiencia Adquirida (SIDA) uno de los sitios primaria y más frecuentemente afectados puede ser la piel. El sitema inmunológico específico de la piel comprende, Células de Langerhans presentadoras de Antígenos (Ags), Linfocitos T dérmicos y epidérmicos y queratinocitos productores de citoquinas, que se encargan de destruir microorganismos invasores y células que expresan neoantígenos tumorales. Estudios ultraestructurales enla piel de pacientes con SIDA, han confirmado daño morfológico y reducción tanto de las células de Langerhans como de los Linfocitos T dérmicos, ocasionados por la presencia del Virus de la Inmunodeficiencia Humana (VIH), lo que disminuiría la respuesta inmune cutánea específica. Las alteraciones cutáneas comprenden un amplio rango, que va desde manifestaciones de tipo infeccioso por agentes comunes y oportunistas como virus, hongos y bacterias, hasta desórdenes vasculares, estados hiperproliferativos y desórdenes neoplásicos cuyo principal exponente es el Sarcoma de Kaposi. El médico debe entonces estar a la expectativa, tratando de identificar tempranos y algunas veces bizarros síntomas relacionados con el SIDA