Polycystic disease in Brazil. Report of five new human cases and a short review of other published observations

This paper describes five additional Brazilian human cases of polycystic hydatid disease due to Echinococcus vogeli, reviews the previous cases reported in Brazil, including one report of E. oligarthus (20 in total), and some epidemiological aspects of this disease which is no longer a curiosity but rather a problem that is not medically easy to handle. Its presence should be expected in any rural area of the New World where humans have not eliminated wild felids/canids, bush dogs, pacas, agoutis and other wild rodents.

Polycystic hydatid disease in Brazil. Report of five new human cases and a short review of other published observations.

This paper describes five additional Brazilian human cases of polycystic hydatid disease due to Echinococcus vogeli, reviews the previous cases reported in Brazil, including one report of E. oligarthus (20 in total), and some epidemiological aspects of this disease which is no longer a curiosity but rather a problem that is not medically easy to handle. Its presence should be expected in any rural area of the New World where humans have not eliminated wild felids/canids, bush dogs, pacas, agoutis and other wild rodents.

Pentavalent antimonial nephrotoxicity in the rat

Estudou-se a funcao renal de ratos tratados com Glucantime (Antimoniato de Meglumine, Rhodia) e Pentostam (estibogloconato de Sodio, Wellcome) na dose de 30 mg de "Sb POT v" por 100g de peso por dia, durante 30 dias. Observou-se um disturbio na concentracao urinaria, que foi reversivel 7 dias apos cessada a administracao das drogas. O estudo histopatologico do rim, por meio da microscopia optica, nao evidenciou alteracoes significativas. Por outro lado, ratos tratados com altas doses dos antimoniais (220mg de "Sb POT v" por 100g de peso por dia) mostraram alteracoes funcionais e histopatologicas renais compativeis com necrose tubular aguda

Pentavalent antimonial nephrotoxicity in the rat.

Aspects of the renal function were assessed in rats treated with the pentavalent antimonials Glucantime (Meglumine Antimoniate, Rhodia) or Pentostam (Sodium Stibogluconate, Wellcome). In dose of 30 mg of Sbv (Glucantime or Pentostam) by 100 mg of weight by day for 30 days, renal functional changes were observed consisting of disturbances in urine concentrating capacity. Such disturbances were expressed by significantly low values of urine osmolality as compared to the basal values previous to the drugs. The decrease in urine osmolality was associated to a significant increase in urinary flow and in negative free-water clearance. There was no alteration in osmolar clearance and in fractional excretion of sodium. These observations suggest an interference of the drugs in the action of the antidiuretic hormone. The disturbance in urine concentration was reversible after a seven days period without the drugs administration. No significant histopathological alterations were observed in the kidneys of the rats treated with the drugs. On the other hand, the rats treated with a high dose of Pentostam (200 mg/100 grams of weight/day) showed the functional and the histopathological alterations of the acute tubular necrosis.

[Human pulmonary adiaspiromycosis. A new case of disseminated form]. / Adiaspiromicose pulmonar humana. Novo caso da forma disseminada.

A case of disseminated pulmonary form of adiaspiromycosis is reported. This is the second case of the disease found in Brasilia, DF. The patient, a 42-year-old peasant, lived in Corrente - State of Piaui, where he certainly acquired the infection. He was admitted to the Social Security Hospital, in Brasilia, with fever, chills, dry cough and dyspnea. At that time, he had been sick for about ten months and the decision of seeking medical care in Brasilia resulted from an exacerbation of the symptoms that had occurred two months before. At a right thoracotomy for a lung biopsy, disseminated white nodular lesions, a few millimeters in diameter, could be observed on the lung surface. Microscopically, round structures, 300 microns or more in diameter, identified as adiaconidia of Chrysosporium parvum var. crescens were seen in the center of some of these lesions. The tisssue response to the causative agent consisted of microabscesses, surrounded by cells in palisading arrangement, and granulomas of the mixed and foreign body types. The two kinds of lesions were thought to represent evolutive stages of the inflammatory process, and to be related to different exposures to the conidia, on separated occasions. The suppurative lesions would be recent lesions, started some weeks or a few months before, while the others, in which the granulomatous reaction predominated, were possibly older lesions, with an evolutions of at least several months.

[Indirect immunofluorescence in endemic pemphigus foliaceus. A contribution to its standardization]. / Imunofluorescência indireta no pênfigo foliáceo endêmico. Contribuição para sua padronização.

The aim of the present research was to standardize the indirect immunofluorescence reaction for Endemic Pemphigus Foliaceus (Fogo Selvagem). We found that fresh human skin was the ideal substrate and could proceed from foreskin, head, neck, or anterior abdominal wall. PBS pre-washing of the skin preceding the incubation with the serum should be avoided since the antigenicity might be diminished. TAS-calcium pre-serves the Pemphigus antigenic properties of the skin and shall be preferred as the diluent for the sera. Albumin-coated slides are useful because they increase the adherence of the skin sections. The conjugate appropriate dilution is convenientely determined by the radial immunodiffusion test (Ouchterlony method). So far as the correlation between the antibody titer and the clinical activity is concerned, we concluded that a titer of 160 or more was of bad prognosis, since it was associated with the generalized form of the disease or with cases of the localized form refractory to the usual therapy. Nevertheless, this assumption needs confirmation by further studies involving an appropriate clinical approach.

[A fatal case of human pulmonary adiaspiromycosis]. / Caso fatal de adiaspiromicose pulmonar humana.

A fatal case of human pulmonary adiaspiromycosis is reported. The patient, a male farm laborer from Pernambuco, in the Northeastern part of Brazil, had moved to Planaltina, DF., one year prior the onset of his illness. The main clinical manifestations consisted in fever, myalgia, cough and dyspnea. After being sick for five weeks, the patient developed severe respiratory failure and died. Grossly, disseminated nodular lesions, a few millimeters in diameter, were observed throughout the lobes of both lungs. Microscopically, round structures, up to 600 microns in diameter, with a thick membrane, identified as adiaconidia of Chrysosporium parvum var. crescens, were seen in the center of the nodular lesions. These adiaconidia appeared predominantly inside microabscesses or necrotic areas, both surrounded by a granulomatous reaction. The pulmonary alveoli not affected by the nodular lesions contained an inflammatory exudate composed of macrophages and neutrophils. The finding of several non-fatal cases of the disease in the area of the Federal District suggests that adiaspiromycosis is endemic in the Central Brazilian Plateau region, where the dry, warm and windy climate, particularly from August to October, may provide the appropriate environmental conditions for the dissemination of C. parvum conidia.

[Normal-pressure hydrocephalus and cerebellar hematoma. Report of a case with necropsy]. / Hidrocéfalo com pressão normal e hematoma cerebelar. Registro de um caso com necropsia.

The authors report the case of a 64-year-old man who presented normal pressure hydrocephalus in the course of hypertensive and arteriosclerotic vasculopathy confirmed by postmortem examination. A blood clot was found on the central area of the left cerebellar hemisphere. The clinical features and the pathogenesis of normal pressure hydrocephalus and cerebellar hemorrhage are reviewed and discussed.

Hidrocefalo com pressao normal e hematoma cerebelar: registro de um caso com necropsia. / Normal pressure hydrocephalus and cerebellar hematoma: report of a case with necropsy

Os autores apresentam o caso de um paciente com hidrocefalia normotensa na vigencia de doenca hipertensiva, ambas confirmadas pela autopsia que, adicionalmente, revelou um hematoma cerebelar esquerdo.Uma discussao e empreendida em torno de varios aspectos da hidrocefalia con pressao normal e do hematoma cerebelar

Resultado do tratamento da leishmaniose tegumentar com benzonidazol. / Results of the treatment of cutaneous leishmaniasis with benzonidazole

Foi realizado um breve ensaio terapeutico com benzonidazol (Rochagan), em seis pacientes portadores de leishmaniose tegumentar com lesoes apenas cutaneas. A droga foi usada na dose diaria de 7mg/kg/dia, em duas tomadas, durante 60 dias. Dos seis pacientes, quatro permanecerem com as lesoes abertas, apesar da terapeutica, revelando apenas uma discreta melhora inicial, pelo exame histopatologico.O 2o caso teve a lesao inicial de braco esquerdo cicatrizada, mas apareceu nova lesao em outro local. Apenas um caso teve cura clinica embora a histopatologia tivesse revelado infiltrado linfocitario residual. Concluiu-se que o benzonidazol nao e eficaz no tratamento da leishmaniose

Novo caso de angiostrongilose abdominal. / A new case of abdominal angiostrongyliasis

E apresentado o caso de uma crianca do sexo feminino de 5 anos de idade que apresentava uma massa palpavel na fossa iliaca direita.Havia leucocitose com intensa eosinofilia (52%). Levada a cirurgia foi encontrada uma massa nodular na juncao ileo-cecal tendo sido ressecados em bloco o ileo terminal, ceco e apendice. O exame da peca cirurgica mostrava espessamento da parede do ceco com areas de necrose de permeio. Histologicamente havia denso infiltrado eosinofilico por toda a parede com alguns vasos arteriais da serosa e submucosa apresentando em seu lumen seccoes transversais de parasitos identificado como sendo Angiostrongylus costaricensis e outros exibindo trombose intravascular. O presente registro constitui o quinto caso brasileiro de parasitismo por esse angiostrongilideo

Histopatologia da leishmaniose tugumentar. / Histopathology of cutaneous leishmaniasis

Foram estudados 245 casos de Leishmaniose Tegumentar, sendo 149 da Regiao Amazonica e 96 da regiao centro oeste. De cada caso analisaram-se 40 variaveis histopatologicas.O acometimento das superficies mucosas esteve praticamente ausente nas formas agudas,em contraste com o que se observou nas formas cronicas, onde ele ocorreu em 50% dos casos estudados.Na regiao centro-oeste, a carga parasitaria foi bem mais reduzida que na regiao Amazonica mesmo nos casos recentes.Nao houve diferenca, estatisticamente significante,entre as lesoes cutaneas e mucosas, nas formas cronicas, quanto as caracteristicas histopatologicas observadas. As lesoes verrucosas ocorreram somente nas formas cronicas. A epiderme persistentemente irritada pelo processo inflamatorio apresentou resposta dicotomica: crescimento exofitico que nos casos cronicos evoluiu para a lesao verrucosa ou crescimento endofitico, a partir das bordas das ulceras, com o desenvolvimento de hiperplasia pseudoepiteliomatosa. Excepcionalmente a hiperplasia evoluiu para o carcinoma epidermoide. Nas formas agudas, foram observados necrose fibrinoide e deposito hialino na parede dos vasos, associado ou nao a trombose. A localizacao destas lesoes nas proximidades e mesmo nas bordas das ulceras foi interpretada como um fator importante na genese formal da ulcera leishmaniotica