Itraconazole and fluconazole in three neuro-paracoccidioidomycosis patients / Itraconazol e fluconazol em 3 pacientes com neuro-paracoccidioidomicose (PBM) cerebral

Three paracoccidioidomycoses (OBM) patients: Male, age 44,51 and 53 years old, form workers, heavy smokers, alcoholics were admitted in to Emílio Ribas Hospital, Såo Paulo, SP, with dyspnea, expectorative cough in all of them and evolutive cardiac edema in two C.O.P.D. inpatients. Hypertensive / nephropathy - 2, adenopathy - 2, clubbing finger, Cor pulmonale (C.O.P.D.), hepatoesplenomegaly and severe interstitial bilateral infiltrate lung lesions were related in 2 patients. Encephalopaty and cerebelar ataxia in one, focal convulsive crises, hypoastesia right arm and Mingazzini neurologic examens were observed in two patients. Paracoccidioides brasiliensis was recovered from bronchoscopy. Pulmonary function showed: bronchodilator no response and 2 mixels test, hypergamaglobulinemia, increases seric level alcaline phosphatase in 3, policytemia in 2 and complement fixation reaction rancing from 1/8 to 1/64 with negative counter immunoelectrophoresis, like laboratorial examens. Berebral C.T. -scan confirmed active nodules in three and cerebelar abscess in one. Azoles therapy revealed one early deth and after 18 months the presence of active nocules (C.T.-scan skull) in 2 of all chronic lung PBM patients

[Lyme disease. Report of a case observed in Brazil]. / Doença de Lyme. Relato de um caso observado no Brasil.

Lyme disease is an infectious disease caused by spirochete Borrelia burgdorferi transmitted by Ixodid tick bite. The geographic distribution of the disease is universal, but the disease has not been identified definitely in South America yet. We report a probable case of Lyme disease in a woman, living in Jaguaré slum (São Paulo), who showed characteristics skin lesions of erythema chronicum migrans, with fever, weakness, headache, muscular pain, cough, arthralgia and sensitive radicular neuropathy in the left arm. The sequential serology made by ELISA method, using Borrelia burgdorferi whole sonicated antigen from Dr. Allen C. Steere laboratory, showed high titers of IgM antibody (1:1600). Because of the persistence of high IgM response for two months, we decided to treat the patient with tetracycline 2g/day during 10 days and the sorology became negative two months. The western blotting confirmed ELISA results showing presence of five bands (IgM). This report fulfills CDC criteria for Lyme disease diagnosis.