RESUMEN
OBJECTIVES: The aim of the study was to analyse the diagnostic performance of the basophil activation test (BAT), to compare the diagnostic reliability of BATs performed with different types of allergens, which are available in Slovakia and to verify the correlation between the symptom severity and the sensitivity and specificity of the BAT in 114 patients with suspected hymenoptera venom allergy (HVA). BACKGROUND: Diagnosis of the HVA and the identification of the appropriate venom for immunotherapy are in Slovakia based on detailed patient'medical history, skin tests and detection of sIgE. In unclear cases, where the clinical decision regarding the relevant insect species for immunotherapy is difficult, the cellular tests are recommended in several countries, such as Sweden, Spain, Germany, Denmark and Italy. In Slovakia, BAT is not adapted as s part of routine diagnostic work-up. METHODS: The identification of the culprit hymenoptera species among 114 patients was based on detailed history, skin tests and detection of sIgE. Obtained results were compared with the results acquired by the BAT. RESULTS: The sensitivity of the BAT was 80.8 % and the specificity was 87.8 %. The sensitivity of the BAT was higher when using Soluprick SQ Allergens, but the specificity was higher with BUHLMANN CAST Allergens. In the study no correlation between the symptom severity and the sensitivity and specificity of the BAT was observed. CONCLUSIONS: The results show that the BAT can be recommended in the identification of the appropriate venom for immunotherapy, the only specific treatment that is currently available for patients with HVA. Allergen source is one of critical factors in diagnostic reliability of the BAT (Tab. 4, Ref. 29) Keywords: hymenoptera venom allergy, allergy diagnosis, basophil activation test, sensitivity, specificity.
Asunto(s)
Venenos de Artrópodos , Himenópteros , Hipersensibilidad , Mordeduras y Picaduras de Insectos , Animales , Basófilos , Humanos , Hipersensibilidad/diagnóstico , Inmunoglobulina E , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: The aim of the study was to evaluate the epidemiological trends in the incidence rates of mother-to-child transmission of syphilis, syphilis in women of reproductive age and pregnant women in the antenatal care program over the period 1991-2014, in order to find a basis for preventive measures. MATERIAL AND METHOD: Case series data of confirmed syphilis was used to evaluate the incidence rates over the period 1991-2014 in Slovakia. RESULTS: During the monitored period, 101 cases of mother-to-child transmitted syphilis were detected. The rate increased in 1996, corresponding to 33.3 per 100,000 live births and discovered discordance in antenatal care program. The rates of syphilis in women of reproductive age showed increased rate in 2001, corresponding to 10.44 per 100 000 population. Pregnant women reported the highest rate in 2000, corresponding to 3.24 per 1,000 pregnant women population. Syphilis notification rates in all three groups showed increased trend in the first decade following with decreased trend in the second decade. The high decrease in rate notification among pregnant women in 2011 (0.37) decreasing up to 0.11 in 2014 was followed with decreasing of mother-to-child transmission. CONCLUSION: Mother-to-child transmission of syphilis poses a public health problem and requires comprehensive surveillance in all countries. These data result in the requirement of effective improvement of antenatal care program in pregnant women. The last years 2011-2014 showed improvement in antenatal care program corresponding with decrease rate of mother-to-child transmission of syphilis.
Asunto(s)
Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo , Sífilis , Niño , Femenino , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Atención Prenatal , Eslovaquia/epidemiología , Sífilis/epidemiologíaRESUMEN
OBJECTIVES: The aim of this study was to evaluate the epidemiological situation of syphilis in the Slovak Republic in the period of the past two decades. BACKGROUND: In last decade, the incidence of syphilis has decreased in European countries by 13%. However, several countries reported an increase in the trend of syphilis. METHODS: Cases of syphilis reported to the National Health Information Center in the Slovak Republic were statistically evaluated. RESULTS: In the first decade syphilis possessed an increase rate 262.5% and 127.6% in five subsequent year intervals, and then the rate fluctuated and showed minimal decrease in the last three years. The highest rate 7.3 per 100,000 population documented in 2009. The peak in the Bratislava region reached 36.36 in 2000. Epidemic was documented in marginalized group in East region. Early syphilis was the most frequent stage observed in both decades but late and no specified cases increased in the last period. The M/F rate was up to 1.7, the most frequently recorded age category was 15-24 years. CONCLUSION: These results indicate a requirement for developing a comprehensive control and educational program in the overall population, particularly in marginalized groups, and improving case management by health providers (Fig. 3, Ref. 20).
Asunto(s)
Sistema de Registros , Sífilis/epidemiología , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Eslovaquia/epidemiología , Adulto JovenRESUMEN
The current work describes an association between pemphigus vulgaris (PV) and class II HLA alleles in the Slovak population, the first such study in Slovakia on the 'high-resolution level'. This work takes into account the new HLA allele nomenclature, officially adopted in 2010. In particular, we have focused on the associations between PV and DRB1*14:54 and DRB1*14:01. This case-control study was performed in a cohort of 43 PV Caucasian patients and 113 Caucasian control subjects from Slovakia. HLA typing was performed using PCR-SSP (polymerase chain reaction with sequence-specific primers). We found significantly positive associations between PV and the HLA alleles DRB1*04:02, DRB1*04:04, DRB1*14:54, DRB1*14:04, DRB1*14:05, DQB1*03:02 and DQB1*05:03. In contrast, HLA-DQB1*06, DRB1*07 and DRB1*13 were negatively associated with PV. Importantly, 93% of PV patients possessed at least one of two HLA haplotypes, DRB1*04-DQB1*03 or HLA-DRB1*14-DQB1*05. We confirmed the previously reported associations between HLA class II alleles and PV and described a new association between PV and DRB1*14:54. This allele was first described in 2005, and there has been only one report of its association with PV to date.
Asunto(s)
Predisposición Genética a la Enfermedad/genética , Cadenas HLA-DRB1/genética , Haplotipos , Pénfigo/genética , Adulto , Anciano , Anciano de 80 o más Años , Alelos , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Frecuencia de los Genes , Predisposición Genética a la Enfermedad/etnología , Genotipo , Prueba de Histocompatibilidad/métodos , Humanos , Masculino , Persona de Mediana Edad , Pénfigo/etnología , Reacción en Cadena de la Polimerasa/métodos , Eslovaquia , Población Blanca/genéticaRESUMEN
Skin squamous cell carcinomas (SCCs) are arguably the second most common carcinoma of the skin and are responsible for the majority of non-melanoma skin cancer deaths. Gynecologist treated a Caucasian 56-years old female patient for genital wart with podophyllotoxin cream. She did not achieve complete response and therefore she has interrupted the therapy and the collaboration with the gynecologist. At the time of evaluation the lesion had a size of man's palm in anogenital region and showed characteristic features of neoplasm. The regional lymph nodes have produced infiltrated painful bubo. PCR analysis for HPV proved negative. Histopathology revealed well-differentiated squamous cell keratinizing carcinoma from the tumor as well as from the regional lymph node packet. Staging computed tomography scans proved negative and pelvis scans disclosed regional lymphadenopathy underlying the tumor. Palliative radiation therapy (by linear accelerator) was administered for the oversized tumor to the total TD 50.0Gy. The patient died 6 months after diagnostic assessment from cardio-respiratory failure. Staging computed tomography before her death did not disclose distinct metastases in her inner organs. Well-differentiated squamous cell keratinizing carcinoma could be growing endophytically affecting the underlying adipose tissue and musculature, with spreading into the regional lymph nodes. The rate of metastases into inner organs seems to vary according to the aggressiveness and metastatic behavior of each SCC. The case report calls for attention to the importance of collaboration among various specialists assisting in the diagnosis and management of skin neoplasm (Fig. 5, Ref. 12). Full Text in PDF www.elis.sk.
Asunto(s)
Neoplasias del Ano/patología , Carcinoma de Células Escamosas/patología , Neoplasias Cutáneas/patología , Neoplasias de la Vulva/patología , Nalgas , Femenino , Humanos , Persona de Mediana Edad , Invasividad NeoplásicaRESUMEN
Palliative cancer care is an active treatment and nursing intervention in patients in whom cancer therapy has been withdrawn due to untreatable progression of the cancer disease. The main aim of palliative cancer care is to ensure the best possible quality of life of a cancer patient and the patient's family members. Palliative cancer care is provided in two basic forms, general and specialized. In the present paper, the authors discuss palliative cancer care and its implementation into clinical practice with reference to their own experience in providing this care.
Asunto(s)
Neoplasias/terapia , Cuidados Paliativos , Cuidado Terminal , Humanos , Calidad de VidaRESUMEN
BACKGROUND: Pemphigus vulgaris is a rare chronic autoimmune disease of skin and mucous membranes, with several cytokines participating in its development. The role of their gene polymorphisms in susceptibility to the disease is, however, not fully understood. OBJECTIVE: The aim of our case-control study was to investigate whether some of 22 single nucleotide polymorphisms (SNPs) in 13 cytokine genes (IL-1alpha, IL-1beta, IL-1RI, IL-1Ra, IL-4Ralpha, IL-12, IFN-gamma, TGF-beta1, TNF-alpha, IL-2, IL-4, IL-6 and IL-10) are associated with pemphigus vulgaris in the Slovak population. METHODS: DNA samples were obtained from 34 pemphigus vulgaris patients and 140 healthy controls of Slovak origin. Cytokine gene SNPs were determined using the polymerase chain reaction with sequence-specific primers (PCR-SSP) method. Results We found a weak association between pemphigus vulgaris and polymorphic variants in TNF-alpha and IL-10 genes only, with haplotypes TNF-alpha-308G/-238G and IL-10 -1082A/-819C/-592C being significantly overrepresented in pemphigus vulgaris patients (TNF-alpha GG: 94.12% vs. 82.86%, P = 0.0216; IL-10 ACC: 44.12% vs. 30.00%, P = 0.0309). CONCLUSIONS: Our preliminary results suggest that certain TNF-alpha and IL-10 gene polymorphisms might contribute to genetic susceptibility to pemphigus vulgaris; however, their overall impact on disease development will be rather limited.
Asunto(s)
Interleucina-10/genética , Pénfigo/genética , Polimorfismo de Nucleótido Simple , Factor de Necrosis Tumoral alfa/genética , Femenino , Predisposición Genética a la Enfermedad , Haplotipos , Humanos , Masculino , EslovaquiaRESUMEN
BACKGROUND: Norwegian or crusted scabies is considered a rare affection and presumably represents an abnormal host immune response to Sarcoptes scabiei. As the condition mimics a range of dermatoses, it can be easily misdiagnosed and mismanaged. CASE REPORT: A 85-year-old woman suffering from bullous pemphigoid was referred for evaluation with presumptive diagnosis of an adverse drug reaction to hydrochlorothiazide or lacipil. Systemic corticosteroid therapy as the mainstay in the control of the bullous skin disorder was increased, but the skin condition worsened. ELISA for the detection of antibodies against the drugs suspected of causing hypersensitivity was negative. Histological examination disclosed inflammatory cells in the upper dermis and parasites. Direct microscopy of the scraped material revealed numerous parasites of the Sarcoptes scabiei type. The patient was treated with topical keratolytics following traditional scabicides for twice as long in comparison with the standard protocol. CONCLUSION: Norwegian scabies may be misdiagnosed and mismanaged in immunosuppressed patients. The diagnosis of scabies should always be considered in immunosuppressed patients with pruritus.
Asunto(s)
Errores Diagnósticos , Diuréticos/efectos adversos , Erupciones por Medicamentos/diagnóstico , Hidroclorotiazida/efectos adversos , Huésped Inmunocomprometido , Penfigoide Ampolloso/inmunología , Escabiosis/diagnóstico , Anciano de 80 o más Años , Femenino , HumanosRESUMEN
BACKGROUND: Pemphigus vulgaris (PV) is a rare, chronic life-threatening autoimmune blistering disease of the skin and mucous membranes. METHODS: A retrospective analysis of 31 patients with the diagnosis of pemphigus vulgaris, admitted for hospitalization from January 1996 to December 2006. Descriptive statistics has been used for data evaluation. RESULTS: The average age at onset was 49.0 +/- 16.2 years, with female to male ratio 1.4/1. Diagnosis was confirmed histologically and by a direct immunofluorescence. Mucocutaneous form of PV was observed in 25 patients (80.%), mucous form in 3 patients (9.7%), cutaneuos form in 3 patients (9.7%). Factors preceding the onset of PV were most often viral (38.7%) and bacterial (35.5%) infections, dental focuses (25.8%), stress (16.1%), and contact with chemical substances (16.1%). 6 patients (19.4%) did not indicate any triggering factor. Corticosteroids alone were given to 18 patients, combined with azatioprin or cyclosporin to 13 patients, and 1 patient was treated with intravenous immunoglobulin. Adverse events were mostly osteopenia/osteoporosis (41.9%), hyperlipoproteinemia (41.9%), cataract (32.3%) and Cushing's syndrome (32.3%). Cutaneous and mucous infections were most often caused by Staphylococcus aureus and Candida albicans, respectively. 3 patients died (9.7%), and in 3 patients (9.7%) in a long term remission, the immunosuppressive treatment was discontinued. CONCLUSION: Pemphigus vulgaris is still a life-threatening disease. Although corticosteroids dramatically improved the mortality, and are still considered the first-choice therapy, significant morbidity of the disease and the corticosteroid treatment still exists. The combination of corticosteroids with corticosteroid-sparing agents delays the onset of adverse events (Fig. 2, Ref. 33).
Asunto(s)
Pénfigo , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pénfigo/complicaciones , Pénfigo/tratamiento farmacológico , Pénfigo/patología , Adulto JovenRESUMEN
Hairy cell leukemia (HCL) is a rare B-cell lymphoproliferative disease, accounting for about 2-3% of all leukemias in adults. The skin lesions were described in about 10-12% of patients. Vasculitis in lymphoproliferative disease is relatively uncommon and may predate the diagnosis of lymphoproliferative disease. A 54-year old female with one month history of general symptoms and sudden onset of maculopapular exanthema on the skin, suffered from anemia, leukopenia and thrombocytopenia. Examination of the skin biopsy revealed lymphocytic vasculitis. Immunophenotyping of the skin biopsy revealed cell population with CD45RO, and small groups with CD20, partly DBA44 positivity. Bone marrow trepanobiopsy showed 50% infiltration with medium-sized lymphoid cells with clear cytoplasm and immunophenotypic coexpression of CD20 and DBA-44 antigens. The diagnosis of HCL was confirmed by flow cytometry of the bone marrow and of the peripheral blood cells that revealed pathological cell population with expression of CD11c, CD19, CD25, CD103. The patient was successfully treated with a single dose of cladribrine. The patient with acute vasculitis should be screened and monitored for possible lymphoproliferative diseases. Skin manifestation of acute vasculitis accompanied with hairy cells may be the first manifestation of HCL. Purine nucleoside analogue cladribrine is considered as the first line of therapy for HCL and induces a total response in more than 80% of cases with HCL.
Asunto(s)
Leucemia de Células Pilosas/complicaciones , Síndromes Paraneoplásicos/complicaciones , Vasculitis/complicaciones , Femenino , Humanos , Persona de Mediana Edad , Enfermedades Cutáneas Vasculares/complicacionesRESUMEN
BACKGROUND: Effective antibiotic therapy administered early in the course of the clinical presentation of erythema migrans (EM) prevents further progression of infection and dissemination of the agent to internal organs. CASE REPORT: A 73-year old woman was referred with a history of five episodes of recurrent EM after repeated adequate antibiotic treatment. The patient who had visited an endemic area only once before the disease recalled no tick bite either prior to the first episode or later. After the first episode, the serological examination was negative (IFA, ELISA, Western blot). In the second episode, not preceded by her visit to any endemic area, the patient showed borderline positivity. Western blot confirmed Borrelia burgdorferi sensu lato. The following episodes were observed again without a prior visit to any endemic area. The most recent EM episode was accompanied by nonspecific moderate symptoms such as fatigue and malaise without involvement of internal organs, with the same serological result as found previously. Peripheral blood PCR assay detected Borrelia burgdorferi specific DNA. Intravenous cephalosporin was effective in treating both the skin and extracutaneous signs of the disease. CONCLUSION: Recurrent episodes of appropriately treated EM may occur as a result of either reinfection due to contact with another vector tick or persistent infection. Intravenous cephalosporin is likely to be appropriate therapy for recurrent borrelial infection in the skin, in particular when accompanied by general extracutaneous signs and symptoms that might indicate dissemination of the spirochetes.
Asunto(s)
Eritema Crónico Migrans/diagnóstico , Anciano , Antibacterianos/uso terapéutico , Eritema Crónico Migrans/tratamiento farmacológico , Eritema Crónico Migrans/patología , Femenino , Humanos , RecurrenciaRESUMEN
UNLABELLED: Determination of antibodies against Borrelia burgdorferi has supporting value in the diagnose of Lyme disease. The purpose of this study was to determine the production of antibodies in a defined group of patients. MATERIAL AND METHODS: The study analysed antibodies in the group of 25 patients with erythema migrans. For the detection of antibodies Immunofluorescence methods, ELISA and Western blot were used. RESULTS: The detection of antibodies by Imunoflorescence methods proved positivity of the titre 1:256 in 14 patients and 9 patients were borderline, with the titre 1:128. Majority of the antibodies detected were of IgM class. The ELISA IgM test found positive reaction in 12 patients and 2 borderline results. IgG antibodies were found significantly more often by ELISA test than by Immunofluorescence. The Western blotting results were IgM positive in 9 patients, 6 were borderline. Only 5 patients have positive IgM results in all tests (Immunofluorescence, ELISA and at least one positive result out of three IgM Western blots). DISCUSSION AND CONCLUSION: The tests which detect Borrelia burgdorferi antibodies are not standardized. They have variable sensitivity and specificity and their standardization is complicated with respect to great heterogenicity of Borrelia burgdorferi strains circulating in individual regions of Europe. The high specificity of antibodies to individual borrelia antigens are presently pointing towards the need to use, when in diagnostic confusion, more tests, which could detect antibodies also to other borrelia antigens (Tab. 3, Ref. 14). Full Text (Free, PDF) www.bmj.sk.
Asunto(s)
Anticuerpos Antibacterianos/sangre , Borrelia burgdorferi/inmunología , Eritema Crónico Migrans/diagnóstico , Borrelia burgdorferi/aislamiento & purificación , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Enfermedad de Lyme/diagnóstico , Pruebas SerológicasRESUMEN
BACKGROUND: Primary cutaneous B-cell lymphoma (PCBCL) has only recently been recognized as a distinct clinicopathological entity which is characterized by an expansion of hematopoietic cells in the special microenvironment of the skin with no evidence of extracutaneous disease within the first six months after staging. PCBCLs represent heterogeneous lymphoproliferative conditions comprising 20-25 % of all cutaneous lymphomas. A CASE REPORT: A Caucasian, sixty five years old female patient with a 4-year history of asymptomatic nodular lesion in the lumbosacral region, firm-elastic to touch and painless, red-purple with smooth surface covered with multiple papules, was referred for the evaluation. Histopathological examination disclosed perivascular lymphocytic infiltrates in the upper part of the dermis, composed of medium-sized lymphocytes with light cytoplasm, especially in deeper dermis margining with fat tissue. Immunohistochemically, the tumor cells were CD20 positive, with a low admixture of CD45RO, CD3 and CD43-positive cells mostly at the periphery of the lesion. The tumor cells exhibited membrane or cytoplasmic expression of immunoglobulins with kappa light chains restriction. DIAGNOSIS: Primary cutaneous marginal-zone B-cell lymphoma (PCMZL). The surgical excision was suggested. The patient is in a complete remission at the 3-year follow-up. CONCLUSION: The primary B lymphoma is more frequently present then considered. The numerous lesions previously thought to be pseudolymphomas are genuine B lymphomas with a low grade malignancy. It is necessary to consider this condition in the differential diagnosis (Fig. 5, Ref. 12). Full Text (Free, PDF) www.bmj.sk.
Asunto(s)
Linfoma de Células B/patología , Neoplasias Cutáneas/patología , Anciano , Femenino , HumanosRESUMEN
Two Caucasian sisters, XZ and YZ, suffered from DH. However, the clinical course of their diseases was different; patient XZ, contrary to her sister YZ, suffered besides dermatitis herpetiformis (DH) also from coeliac disease (CD) and an autoimmune thyroid disease. The sisters were ordered to adhere to gluten-free diet and dapsone was prescribed, however, patient XZ developed a hypersensitivity to dapsone. The HLA typing disclosed that they were homozygous and that they shared HLA alleles DQB1*0201. Our results confirm the known association of DH to other autoimmune disorders and its well established association the HLA-DQB1*0201 allele. Although DH is generally not regarded as a familial disease our case report suggests its familial character (Fig. 3, Ref. 10). Full Text (Free, PDF) www.bmj.sk.
Asunto(s)
Dermatitis Herpetiforme/genética , Adulto , Enfermedad Celíaca/complicaciones , Enfermedad Celíaca/genética , Dermatitis Herpetiforme/complicaciones , Dermatitis Herpetiforme/patología , Femenino , Antígenos HLA-DQ/sangre , Cadenas beta de HLA-DQ , Humanos , Tiroiditis Autoinmune/complicacionesRESUMEN
BACKGROUND: Endothelial cells have a pivotal role in the initiation and development of inflammation. The dermal microvasculature undergoes distinctive morphological changes. Central to the angiogenetic process are endothelial cell division and migration controlled by local expression of the mitogenic factor. There is considerable evidence for the development of angiogenesis in psoriatic skin. Quantitative assessment of the endothelium in psoriasis demonstrated a fourfold increase in surface area of the superficial vascular plexus in lesional skin. The rate of vascular proliferation in active psoriasis is similar to that in other angiogenic pathologies. To identify vasoproliferation in the skin adds a useful tool in the assessment of psoriasis activity in future studies of its pathogenesis. The basal level of endothelemia reflects a continuous replacement of cells. The hyperproliferation in psoriasis stimulates physiological cell replacement. The higher replacement of blood vessel endothelial cells causes an increase in circulating cell levels in the bloodstream. Endothelemia might serve as an indicator of changes in the blood vessel endothelium in psoriatics. OBJECTIVE: The aim of the present study was to assess the changes in the amount of endothelial cells in the blood of psoriatic patients by comparing them with healthy controls. MATERIAL AND METHODS: Fifty-six patients suffering from psoriasis (PASI score 35.05 +/- 5.61) and 20 healthy subjects were estimated for quantitative endothelemia using the counting of endothelial cells in Burker's chamber after their isolation together with platelets and the removal of the latter by addition of adenosine diphosphate. The cells were confirmed as endothelial in origin by positive staining for von Willebrand factor. The significance of the differences was estimated by Student's t-test. RESULTS: There were 2.02 +/- 0.21 (female) and 2.3 +/- 0.25 (male) endothelial cells in the control group and 4.6 +/- 0.59 (female) and 5.15 +/- 0.67 (male) in the psoriatic patients. The difference was statistically significant (P < 0.001). CONCLUSION: Expansion of the dermal microvasculature is a prominent feature in psoriasis. Endothelemia might be an indirect marker of changes in the blood vessel endothelium in psoriatic patients. No differences were found in endothelemia in psoriatics according to the gender.
Asunto(s)
Endotelio Vascular/patología , Psoriasis/fisiopatología , Adolescente , Adulto , Anciano , Biomarcadores/sangre , Estudios de Casos y Controles , División Celular , Femenino , Humanos , Masculino , Microcirculación , Persona de Mediana Edad , Psoriasis/patologíaRESUMEN
60-70% of Lyme borreliosis is formed by early manifestations, in particular erythema migrans (EM). All vegetative forms of the tick Ixodes ricinus (e.g. full grown tick, nymphae and larvae) transmit the causal organism, the spirochete Borrelia burgdorferi sensu stricto and Borrelia burgdorferi sensu lato (B. garinii, B. afzelii). The objective of the work was to evaluate clinical and epidemiological parameters and to contribute by testing and investigating in greater detail criteria to the early and exact diagnosis of the disease. In a group of 50 patients the time of development of EM was evaluated, the mode of transmission, the incubation period, localization, symptoms of dissemination of B. burgdorferi, the period of treatment and the antibiotic used. The dynamics of the antibody titre against B. burgdorferi (IFA test) were assessed in 21 patients with EM for a period of 1 to 22 months and in 5 patients with acrodermatitis chronic atrophicans (ACA) for 3 to 55 months. In 50% EM developed during the summer months. 66% reported as the vector a tick, 14% insects and 20% did not know. An incubation of 1 and 2 weeks was reported in 34%, the lower extremities were affected in 52%. Manifestations of dissemination were found in 6 patients, in 2 patients EM relapsed. Antibodies (Ab) against B. burgdorferi were present in 38 patients. In 21 patients the dynamics of the antibody titre were followed up for 1 to 22 months and no substantial changes were found. Serum positivity in patients with ACA persisted without change of the titre for several years. In the treatment of EM most frequently doxycycline was administered for two weeks. EM as the early stage of LB is a seasonal disease with a natural focus. If treatment is started in the early stage of infection, antibodies against B. burgdorferi need not develop. There is no correlation between clinical complaints and serological results and the type of treatment. The prognosis of the disease is favourable in the majority of patients. Vaccination offers new possibilities in active protection against Borrelia infection, in particular in endemic areas. For European countries at present a recombined vaccine is being prepared from the surface lipoprotein A (OspA) made from prevalent strains of B. afzelii and B. garinii.
Asunto(s)
Eritema Crónico Migrans/diagnóstico , Anticuerpos Antibacterianos/análisis , Grupo Borrelia Burgdorferi/inmunología , Eritema Crónico Migrans/inmunología , Eritema Crónico Migrans/terapia , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: The role of B. burgdorferi in the etiology of sclerodermia circumscripta (SC) and lichen sclerosus et atrophicus (LSA) are is reported in numerous, however controversial studies. The objective of our study is to approximate the solution of the given problem and to widen these consideration by other diagnoses with multifactorial and unclear etiology such as erythema nodosum (EN), granuloma anulare (GA), erythema anulare (EA) and urticaria chronica. MATERIAL AND METHODS: 124 probands were divided into groups according the diagnoses presented above and compared with the negative control group of 131 probands with dermatologic diagnoses, in which the etiologic agent of B. burgdorferi was not assumed and positive group of 55 probands with lyme boreliosis. Indirect immunofluorescent test was used to find out the tieter of antibodies against B. burgdorferi in all groups by using the endemic strains as antigens, which has caused a higher value of the so-called cut-off. RESULTS: The negative control had a positive titer in 44 cases (n = 131, i.e. in 33.6%). The positive titer was found in 11 probands from the SC group (34.4% =, n = 32), 5 probands in LSA (71.4%, n = 7), 9 probands in the EN group (64.3%, n = 14), 6 probands in the EA and GA groups (42.3%, n = 14) and 19 probands in the group of urticaria chronica (33.3%, n = 57). CONCLUSION: We assume that in the probands with high titers of antibodies, B. burgdorferi could play a role in the etiology of the given diseases titers of antibodies against B. burgdorferi. The draft problem could be solved by modern method including PCR with the use of several primers focused on different antigens regarding the certain epidemiologic regions. (Fig. 7, Ref. 17.)
Asunto(s)
Anticuerpos Antibacterianos/sangre , Grupo Borrelia Burgdorferi/inmunología , Enfermedades de la Piel/microbiología , Adolescente , Adulto , Anciano , Enfermedad Crónica , Eritema/microbiología , Eritema Nudoso/microbiología , Femenino , Granuloma Anular/microbiología , Humanos , Liquen Escleroso y Atrófico/microbiología , Enfermedad de Lyme/inmunología , Enfermedad de Lyme/microbiología , Masculino , Persona de Mediana Edad , Esclerodermia Localizada/microbiología , Urticaria/microbiologíaRESUMEN
The objective of the work was to induce experimental infection with the anthropophil dermatophyte Trichophyton rubrum in animals and to confirm it by clinical, mycological and histopathological examination. For preparation of the inoculum the authors used a T. rubrum culture isolated from patients suffering from dermatomycosis. The inoculum was cultivated under conditions of intensive aeration (shaking). Its density was 2.0 x 10(6)/ml of germinative spores and hyphal fragments. On the animal's back shoved and irritated by scarification (area 4 cm2) 2 ml inoculum were rubbed in. Experimental mycotic infection was induced in one of four guinea pigs and one of two domestic rabbits. The first clinical manifestations of mycotic infection were found on the 6th and 9th day after inoculation. From the focus T. rubrum was cultivated. From the unaffected hair in the close vicinity and at more remote sites numerous contaminants were isolated, other fungi as well as dermatophytes. In the histopathological material the authors found in the shed layers of the stratum corneum PAS positive septate fibres. Numerous PAS positive septate fibres were found also in the hair follicles. In the corium a mixed inflammatory infiltration was present with a predominance of histiocytes and polymorphonuclear leukocytes. No morphological changes were found after passaging the dermatophyte T. rubrum via animals. Guinea pigs and the domestic rabbit are useful animals for inducing experimental infection with the dermatophyte Trichophyton rubrum.