The importance of serological assays in diagnosing acute pulmonary histoplasmosis

Histoplasmosis is a systemic mycosis caused by inhalation of Histoplasma capsulatum microconidia. The disease does not normally affect immunocompetent individuals after a single, transient inhalation exposure. However, longer exposure may cause chronic or disseminated acute pulmonary infection. Herein, we report the case of a 24-year-old immunocompetent patient, who presented fever, cough and dyspnea for one month. The chest radiography revealed interstitial infiltrate and diffuse micronodules. The patient reported having had close and prolonged contact with bats. Diagnosis was confirmed by positive double immunodifusion and immunoblotting assays. She was treated with ketoconazole (400 mg) and there was complete resolution of the disease.

[Acquired epidermolysis bullosa (acquired dermolytic bullous dermatoses) (study of 2 patients)]. / Epidermólise bolhosa adquirida (dermatose bolhosa dermolítica adquirida) (estudo de 2 doentes).

The authors studied two patients with bullous lesions with onset at adult age. There were no relatives with bullous disease. After minor traumas, mainly in hands, feet, elbows and knees, one could see the onset of the blisters, which vanished leaving atrophic scars. Nails and mucosae were involved in both patients. The female patient had cyst of milia. One of the patients had lymph node tuberculosis as associated disease. Through exhaustive clinical examination and laboratory investigation, the authors excluded other types of bullous diseases. Histopathology of the lesions, electron microscopy, direct and indirect immunofluorescence, supported the diagnosis of Acquired Dermolytic Bullous Dermatosis.

[Levels of selenium in urine after treatment of pityriasis versicolor with a 1.0% selenium sulfide]. / Dosagem de selenio na urina após tratamento da pitiriase versicolor com sulfeto de selenio a 1,0%

The treatment of pityriasis versicolor by the topical application of selenium sulfide 1% was studied in two groups of patients. Diagnosis and response to therapy was determined by clinical observation. Wood's light fluorescence, and direct microscopic examination. The efficacy of three different therapeutic regimes was studied in one group by the application of the drug to the entire skin for either five minutes, fifteen minutes, or twelve hours for eighteen days. Each method proved equally effective in resolving the infection. Therefore, the cutaneous application of selenium sulfide 1 % for five minutes daily for eighteen days is the recommended treatment for pityriasis versicolor. The percutaneous absorption of selenium sulfide was also studied in another groups who applied the drug to the entire skin for five minutes for eighteen days. Fluorimetric analysis of urinary samples collected on the third and thirteenth days of treatment revealed no significant increase in the excretion of selenium as compared to pretreatment levels. Systemic toxicity was not observed in any of the patients treated. The results suggest that the selenium sulfide is absorbed poorly from the skin and is a safe and effective therapy for pityriasis versicolor.