RESUMO
Leishmaniasis is a zoonotic disease caused by intracellular protozoa of the Leishmania genus that are spread and transmitted by sandflies. Natural infection and clinical disease in domestic cats and dogs appear to be rare or perhaps largely under-reported in endemic areas. However, previous reports on infected domestic animals usually implicate the same Leishmania species that affect humans in tropical and subtropical areas of the world suggesting a potential role for zoonotic transmission. In the present study we assessed a representative sample of cats and dogs from endemic urban / suburban areas of Lara state in central western Venezuela. In both dogs and cats, cutaneous disease exhibits a spectrum of manifestations that range from single papules or nodules, which may evolve into ulcerative, plaque-like or scaly lesions. Cytochrome b (cyt b) PCR gene sequence analysis revealed L. mexicana as the causative agent in all cases, including two human cases proceeding from the same study area at the same time the study was carried out. In order to improve our understanding on feline/canine infection with Leishmania mexicana, and address potential zoonotic concerns it is necessary to characterize its enzootic reservoirs and vectors as well as the possible anthropophilic players linking to the peridomestic and domestic cycles.
Assuntos
Doenças do Gato/epidemiologia , Doenças do Gato/parasitologia , Doenças do Cão/epidemiologia , Doenças do Cão/parasitologia , Leishmaniose Cutânea/epidemiologia , Leishmaniose Cutânea/parasitologia , Animais , Animais Domésticos , Gatos , Cães , Humanos , Reação em Cadeia da Polimerase/veterinária , Psychodidae/parasitologia , Venezuela/epidemiologia , Zoonoses/epidemiologia , Zoonoses/parasitologiaRESUMO
Zika virus (ZIKV) is an emerging mosquito-borne flavivirus transmitted mainly by Aedes species of mosquitos. Although the infection is usually mild and self-limiting, it is emerging as a public health challenge in tropical and subtropical countries owing to its unprecedented pathogenicity and increased risk for fetal malformations and neurological symptoms. Cutaneous manifestations as for other mosquito-borne viruses remain a hallmark of the disease. This article provides a detailed overview on ZIKV infection, including its varied cutaneous clinical manifestations and diagnostic aspects, and also provides detailed insights into its pathogenesis in human skin.
Assuntos
Exantema/etiologia , Dermatopatias/virologia , Pele/patologia , Infecção por Zika virus/complicações , Zika virus , Diagnóstico Diferencial , Febre/etiologia , Humanos , Infecção por Zika virus/patologiaRESUMO
Zika virus is an emerging arbovirus, which is expanding in epidemic proportions through tropical and subtropical areas of the world. Although Zika is linked to a number of congenital and neurological complications, there is scarce knowledge on the impact of ZIKV infection in human skin. We report the case of a 68-year old woman who presented with generalized pustular psoriasis after a preceding and otherwise uneventful episode of ZIKV infection. Based on recent experimental data on the biology of ZIKV infection in the cutaneous environment, we speculate that ZIKV may have directly triggered the development of generalized pustular psoriasis by stimulation of keratinocyte-derived mediators of inflammation and a polyfunctional T-cell driven immune reaction in the cutaneous milieu.
Assuntos
Psoríase/virologia , Infecção por Zika virus/complicações , Zika virus , Idoso , Eritema/virologia , Feminino , Humanos , Pele/patologia , Zika virus/isolamento & purificação , Infecção por Zika virus/diagnósticoRESUMO
Post-chikungunya chronic inflammatory rheumatism (pCHIK-CIR) is one of the consequences that are impacting new endemic countries, such as those in the Americas. The relative frequency of pCHIK-CIR is highly variable, ranging from 14.4 % to 87.2 % (including variable number of patients and follow-up times). Based on those non-weighted values, it is difficult to estimate which would be the expected number of patients with CHIK who will develop CIR. For these reasons, we modeled weighted estimations based on pooled data extracted from those eight representative studies in order to provide cumulative proportion of pCHIK-CIR over time and median time of it, but also estimations of the number of patients with CHIK reported in Latin American countries (within a 95 % CI). This model estimated a prevalence of 47.57 % for pCHIK-CIR (95 % CI 45.08-50.13), with a median time to 50 % of pCHIK-CIR in 20.12 months. Given the reported number of patients with acute CHIK during 2014 in the Americas, our estimates suggest that from those patients, 385,835-429,058 patients will develop pCHIK-CIR. Despite the limitations of these estimates, the provided figures of pCHIK-CIR presented here are preliminary approximations of what the future burden of related rheumatic disease in the region as a consequence of CHIK infection for 2015-2016 could be, given the timeframe of median time of occurrence.
Assuntos
Febre de Chikungunya/complicações , Doenças Endêmicas , Febre Reumática/epidemiologia , Febre Reumática/etiologia , Feminino , Humanos , América Latina/epidemiologia , Masculino , PrevalênciaRESUMO
Prototheca wickerhamii is an alga that rarely causes human disease but has been reported increasingly among immunocompromised individuals. We report a fatal case of P. wickerhamii in a renal transplant recipient who presented with a cutaneous lesion that led to disseminated disease despite treatment with voriconazole. We reviewed previous cases of protothecosis involving solid organ transplant recipients in the literature and discussed the value of newer microbiology platforms, i.e., matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF), to achieve early diagnosis and impact outcomes.
Assuntos
Hospedeiro Imunocomprometido , Infecções/imunologia , Transplante de Rim , Complicações Pós-Operatórias/imunologia , Prototheca/isolamento & purificação , Evolução Fatal , Humanos , Infecções/diagnóstico , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnósticoRESUMO
American cutaneous leishmaniasis is an endemic anthropozoonosis that exhibits a broad spectrum of clinical presentations. Intermediate/borderline disseminated cutaneous leishmaniasis is a distinct clinical condition that comprises cutaneous disease of a chronic nature, usually occurring as multiple lesions with or without mucosal involvement. The disease is usually caused by parasites of the subgenus Viannia, frequently occurs in context of an underlying disease, and is often resistant to standard antileishmanial therapy. We report a case that was refractory to standard therapy and other second-line drugs, but resolved after treatment with fluconazole, and review the use of fluconazole as a second-line drug in children.
Assuntos
Antifúngicos/uso terapêutico , Fluconazol/uso terapêutico , Leishmania braziliensis , Leishmaniose Cutânea/tratamento farmacológico , Criança , Feminino , Humanos , Leishmaniose Cutânea/parasitologia , Resultado do TratamentoRESUMO
Genotyping and molecular characterization of drug resistance mechanisms in Mycobacterium leprae enables disease transmission and drug resistance trends to be monitored. In the present study, we performed genome-wide analysis of Airaku-3, a multidrug-resistant strain with an unknown mechanism of resistance to rifampicin. We identified 12 unique non-synonymous single-nucleotide polymorphisms (SNPs) including two in the transporter-encoding ctpC and ctpI genes. In addition, two SNPs were found that improve the resolution of SNP-based genotyping, particularly for Venezuelan and South East Asian strains of M. leprae.
Assuntos
Farmacorresistência Bacteriana Múltipla , Mycobacterium leprae/genética , Análise de Sequência de DNA/métodos , Sudeste Asiático , Genoma Bacteriano , Genótipo , Humanos , Hanseníase/microbiologia , Dados de Sequência Molecular , Mycobacterium leprae/classificação , Filogenia , Polimorfismo de Nucleotídeo Único , VenezuelaRESUMO
BACKGROUND: Neurotensin (NT) participates in immune responses, but the mechanisms are not known. We have previously shown that NT augments the ability of corticotropin-releasing hormone (CRH) to increase mast-cell-dependent vascular permeability in rodents. We also showed that NT stimulates human mastcell release of vascular endothelial growth factor, and that CRH is increased in the serum of patients with atopic dermatitis (AD), an inflammatory skin condition involving mast cells. OBJECTIVES: To measure serum levels of NT, and lesional skin expression of NT and the main NT receptor (NTR-1) in AD, and to compare it with skin expression in chronic urticaria (CU) and urticaria pigmentosa (UP). METHODS: Serum NT was measured with a Milliplex microbead array. Skin NT and NTR-1 gene expression was determined with quantitative polymerase chain reaction. Immunohistochemistry was performed using a mouse monoclonal antibody for NT, and a rabbit polyclonal antibody for NTR-1. Mast cells were counterstained with Leder dye. RESULTS: Neurotensin is significantly elevated in the serum of patients with AD compared with healthy controls (P = 0.0001). NT gene expression is also significantly increased in lesional skin of patients with AD compared with controls (P = 0.0194). Moreover, immunohistochemistry of AD lesions shows NT > NTR-1 staining of perivascular cells, many of which are identified as mast cells after staining with Leder dye. There was no statistically significant difference in NT and NTR-1 lesional skin gene expression in patients with either CU or UP. CONCLUSIONS: These results suggest that interactions between NT and mast cells may occur and contribute to AD pathogenesis.
Assuntos
Dermatite Atópica/metabolismo , Neurotensina/metabolismo , Adulto , Dermatite Atópica/genética , Feminino , Expressão Gênica , Humanos , Imuno-Histoquímica , Masculino , Mastócitos/metabolismo , Neurotensina/genética , Reação em Cadeia da Polimerase em Tempo Real , Receptores de Neurotensina/genética , Receptores de Neurotensina/metabolismo , Pele/metabolismo , Urticária/metabolismo , Urticaria Pigmentosa/metabolismoAssuntos
Alopecia em Áreas/patologia , Granuloma/patologia , Adulto , Idoso , Alopecia em Áreas/complicações , Alopecia em Áreas/tratamento farmacológico , Anti-Inflamatórios não Esteroides/uso terapêutico , Clofazimina/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Granuloma/complicações , Granuloma/tratamento farmacológico , Humanos , Couro Cabeludo/patologia , Resultado do TratamentoRESUMO
Lobomycosis, a disease caused by the uncultivable dimorphic onygenale fungi Lacazia loboi, remains to date as an enigmatic illness, both due to the impossibility of its aetiological agent to be cultured and grown in vitro, as well as because of its unresponsiveness to specific antifungal treatments. It was first described in the 1930s by Brazilian dermatologist Jorge Lobo and is known to cause cutaneous and subcutaneous localised and widespread infections in humans and dolphins. Soil and vegetation are believed to be the chief habitat of the fungus, however, increasing reports in marine mammals has shifted the attention to the aquatic environment. Infection in humans has also been associated with proximity to water, raising the hypothesis that L. loboi may be a hydrophilic microorganism that penetrates the skin by trauma. Although its occurrence was once thought to be restricted to New World tropical countries, its recent description in African patients has wrecked this belief. Antifungals noted to be effective in the empirical management of other cutaneous/subcutaneous mycoses have proven unsuccessful and unfortunately, no satisfactory therapeutic approach for this cutaneous infection currently exists.
Assuntos
Doenças Transmissíveis Emergentes/diagnóstico , Doenças Transmissíveis Emergentes/epidemiologia , Golfinhos/microbiologia , Lobomicose/diagnóstico , Lobomicose/epidemiologia , Animais , Doenças Transmissíveis Emergentes/microbiologia , Doenças Transmissíveis Emergentes/veterinária , Modelos Animais de Doenças , Humanos , Lobomicose/microbiologia , Lobomicose/veterináriaAssuntos
Infecções por Mycobacterium não Tuberculosas/patologia , Micobactérias não Tuberculosas/isolamento & purificação , Dermatopatias Bacterianas/patologia , Adulto , Jardinagem , Humanos , Masculino , Infecções por Mycobacterium não Tuberculosas/microbiologia , New York , Dermatopatias Bacterianas/microbiologiaRESUMO
Old World cutaneous leishmaniasis is a widespread and potentially disfiguring protozoal infection that is endemic in the Mediterranean basin, Africa, and parts of Asia. Human infection is caused by several species of Leishmania parasites, such as Leishmania infantum. Available systemic and topical treatments vary in efficacy and are often unjustified due to their toxicity. We report on a case that was treated with posaconazole, a drug typically considered an antifungal agent but which also targets specific metabolic pathways of the parasite.
Assuntos
Leishmania infantum/efeitos dos fármacos , Leishmania infantum/patogenicidade , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/parasitologia , Triazóis/uso terapêutico , Tripanossomicidas/uso terapêutico , Adulto , Feminino , Humanos , Leishmania infantum/genética , Leishmaniose Cutânea/genética , Dados de Sequência Molecular , Reação em Cadeia da PolimeraseRESUMO
American cutaneous leishmaniasis is an important endemic zoonotic disease in the New World that comprises a spectrum of clinical manifestations. Diffuse cutaneous leishmaniasis (DCL) is a rare form of the disease characterized by antigen-specific immunodeficiency that often presents with multiple disfiguring non-ulcerated confluent nodules or plaques that involve large areas of the skin, resembling lepromatous leprosy. Relapse is invariable in advanced stages, despite aggressive chemotherapy, and a plethora of drugs has been tested with unchanging results. We report on a severe an exceptional case that resolved after treatment with amphotericin B, a drug considered only mildly effective, and discuss the therapeutic approach to this disease.
Assuntos
Anfotericina B/uso terapêutico , Antiprotozoários/uso terapêutico , Leishmaniose Tegumentar Difusa/tratamento farmacológico , Adolescente , Dermatoses Faciais/tratamento farmacológico , Dermatoses Faciais/patologia , Humanos , Leishmaniose Tegumentar Difusa/patologia , MasculinoRESUMO
Patients with HIV/AIDS are often afflicted with oesophageal disorders. Opportunistic infections such as candidiasis, herpes simplex, cytomegalovirus, mycobacterial infections, Kaposi sarcoma or lymphoma involving the oesophagus, motility disorders and reflux oesophagitis are the usual culprits. Eosinophilic oesophagitis (EE), a recently recognized entity, is an important cause of dysphagia, food impaction and chest discomfort. We report the case of an HIV-infected man who had persistent dysphagia for six months despite treatment with proton pump inhibitor. He was diagnosed with EE after having endoscopic evaluation and biopsy of his oesophagus and was successfully treated with swallowed fluticasone. This case represents the first reported case of EE in an HIV-infected individual.
Assuntos
Transtornos de Deglutição/etiologia , Esofagite Eosinofílica/diagnóstico , Infecções por HIV/complicações , Adulto , Androstadienos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Biópsia , Endoscopia , Esofagite Eosinofílica/patologia , Fluticasona , Histocitoquímica , Humanos , Masculino , Inibidores da Bomba de Prótons/uso terapêuticoRESUMO
In the Americas, approximately 20 million people suffer from the chronic phases of Chagas' disease, of which chagasic cardiomyopathy is the most important clinical feature. The elimination of Trypanosoma cruzi is a pivotal step in arresting the evolution of the disease. Unfortunately, currently available chemotherapy is mostly ineffective due to its limited efficacy and toxic side effects. The following case highlights the efficacy of new diagnostic and follow-up methods in the evaluation of novel trypanocidal compounds such as amiodarone and itraconazole.
Assuntos
Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Doença de Chagas/tratamento farmacológico , Itraconazol/uso terapêutico , Tripanossomicidas/uso terapêutico , Animais , Doença de Chagas/diagnóstico , Doença Crônica , Quimioterapia Combinada , Ensaio de Imunoadsorção Enzimática , Imunofluorescência , Humanos , Masculino , Pessoa de Meia-Idade , Trypanosoma cruziRESUMO
Chromoblastomycosis is a chronic infection caused by dematiaceous (dark-colored) fungi which affect the skin and subcutaneous tissues, and is characterized by a wide variety of clinical and dermatological features including papillomatous, verrucous and vegetating lesions. Although it has been described world-wide, most cases originate in tropical and sub-tropical areas. In general, present treatments of the disease are unsatisfactory as one of the most common etiologic agents, Fonsecaea pedrosoi is difficult to manage from a therapeutic point of view. We report a case of extensive chromoblastomycosis of 22 years duration caused by F. pedrosoi and review the clinical course, diagnosis and management of this disease.