Broad histopathologic patterns of non-glabrous skin and glabrous skin from patients with a new variant of endemic pemphigus foliaceus-part 1.

A prospective, controlled epidemiologic survey performed in El Bagre, Colombia revealed a new variant of endemic pemphigus disease, occurring in a gold mining region. The disease resembled Senear-Usher syndrome, and occurred in an endemic fashion. The aim of this study is to describe the most frequent histopathologic patterns in non-glabrous skin and in glabrous skin observed in these patients, and their clinical correlation. The study was performed on non-glabrous skin biopsies of 30 patients from the dominantly clinical affected areas (either on the chest, arms or face). Simultaneously, biopsies from the palms were obtained in 10 randomly chosen patients of the 30 total patients. The specimens were examined following hematoxylin and eosin (H&E) staining. The most common blisters observed were subcorneal, although in some cases intraspinous and subepidermal blisters were visualized. Our results showed a very heterogeneous pattern of histopathologic patterns in non-glabrous skin, which seemed to correlate with the clinical features. The most common pattern was typical pemphigus foliaceus-like, with some lupus erythematosus-like features. A non-specific, chronic dermatitis pattern prevailed in the clinically controlled patients taking daily corticosteroids. In the patients who have had the most severe and relapsing pemphigus, early sclerodermatous changes and scleredermoid alterations prevailed in their reticular dermis. In addition to the scleredermoid alterations, the reticular dermis showed a paucity of appendageal structures. On the contrary, in the palms, a similar pattern was seen in all cases, including thickening of the stratum corneum, hypergranulosis, edema in the papillary and reticular dermis and a dermal perivascular lymphocytic infiltrate. The direct immunofluorescence of the glabrous vs. the non-glabrous skin also showed some differences. We conclude that the histopathologic features of this new variant of endemic pemphigus are complex, therefore, classical histopathologic features previously described for superficial, endemic pemphigus cannot be used alone to diagnose this disease.

Descripción de una cohorte de pacientes con criterios de síndrome de respuesta inflamatoria sistémica en dos hospitales de tercer nivel / Description of a cohort of patients with criteria of systemic inflammatory response syndrome (SIRS) in two third-level hospitals

Se ha considerado al síndrome de respuesta inflamatoria sistémica (SRIS), a la sepsis y a las complicaciones que de ellos se derivan, como responsables de un número importante de hospitalizaciones y consultas en los servicios de urgencias en centros de tercer nivel. En nuestro medio muchos aspectos relacionados con la epidemiología, la presentación clínica y la microbiología de estas entidades se encuentran aún por definir.Diseño: estudio de cohorte longitudinal.Población de estudio: pacientes hospitalizados por urgencias en dos hospitales de referencia, con criterios de SRIS de adquisición extrahospitalaria y etiología no traumática, entre agosto 1 de 1998 y marzo 31 de 1999.Metodología: recolección, en el momento de la admisión en urgencias, de variables relacionadas con las características clínicas, epidemiológicas microbiológicas de la cohorte.Resultados: 503 pacientes ingresaron al estudio. El rango de edad osciló entre 14 y 97 años, con un promedio de 49 años. El 46.5 por ciento fueron mujeres. El 27.8 por ciento fueron amas de casa, desempleados el 12.7 por ciento y agricultores el 4.9 por ciento. El tiempo de hospitalización promedio fue de 11.3 días. Los principales diagnósticos de ingreso fueron neumonía, sepsis e infección de tejidos blandos. Los gérmenes más frecuentemente aislados en sangre fueron Staphylococcus aureus, Streptococcus pneumoniae y Escherichia coli, Las complicaciones más frecuentes fueron choque (17.2 por ciento) y síndrome de dificultad respiratoria (13.1 por ciento). El 58.8 por ciento de los pacientes presentaron síndrome de origen infeccioso sin germen cultivado, y entre estos los síndromes predominantes fueron neumonía e infecciones de tejidos blandos. Conclusiones: el SRIS y la sepsis son entidades frecuentes en nuestros hospitales. La población estudiada es heterogénea en cuanto a sus características epidemiológicas, microbiológicas y la edad de los pacientes, pero parece diferenciarse claramente de otras latitudes en cuanto a población más joven y menor tiempo de estancia hospitalaria. Aunque clínicamente se tenga un síndrome infeccioso, en un número importante de pacientes no se aislan los gérmenes responsables. Los principales diagnósticos de ingreso y los microorganismos documentados muestran similitudes con lo informado en la literatura mundial.

Introduction: The Systemic Inflammatory Response Syndrome (SIRS), sepsis and their complications have been considered as an important cause of consult and admission at emergency third-level centers. In our region, many aspects related with epidemiology, clinical presentation and microbiology of this illness are still not defined. Type of study: Longitudinal cohort study. Population: Hospitalized patients who entered through emergency services at reference hospitals, with non-traumatic community-acquired SIRS criteria, between August 1, 1998 and March 31, 1999. Methods: Recollection of clinical, epidemiological and microbiological information on patients with SIRS criteria at admission to emergency services. Results: 503 patients were admitted to the study; age range was between 14 and 97 years, mean 49 years. 46.5% were women, 27.8% were housekeeping women, 12.7% unemployed and 4.9% farmers. Average time of hospitalization was 11.7 days. The main diagnoses at admission were pneumonia, sepsis and soft tissue infections. Staphylococcus aureus, Streptococcus pneumoniae and Escherichia coli were the most commonly isolated bacteria on blood cultures. Shock (17.2%) and adult respiratory distress syndrome (13.1%) were the most common complications. In 58.8% of patients with clinical infectious SIRS, blood cultures were negative; pneumonia and soft tissue infection were the most common diagnoses in this group Conclusion: SIRS and sepsis are common entities in our hospitals. The population of study is heterogeneous in epidemiological, microbiological and age aspects, compared with other regions where it is older and remain hospitalized for longer periods. Although patients with SIRS have clinically an infectious origin, in an important number of them, blood cultures are negative. Main diagnoses of patients with SIRS at admission and the microorganisms isolated from them were similar in our study to those reported in the literature