Ademir Rocha

Efficacy of azithromycin in the treatment of cutaneous leishmaniasis

The present open pilot study was conducted to assess the efficacy of azithromycin for the treatment of patients with cutaneous leishmaniasis in Ara ua and Varzelândia, MG. Twenty-four patients with less of six months of disease evolution were treated after clinical examination, Montenegro test and a biopsy. The treatment schemes consisted of oral doses of 500 mg per day for 3, 5 and 10 days and of 1000 mg for two days. A clinical control was performed monthly and treatment cycles were repeated when necessary until full reepithelialization of the lesions. On the occasion of the final evaluation, 20 patients had completed the study and 17 of them (85%) were cured. The time to obtain a cure was 60 days ifor 6 (30%) patients, 90 days for 7 (35%), and 120 for 4 (20%). The three patients with treatment failure received a pentavalent antimonial for 20 days. No adverse reactions to the medication were observed and a 14 month follow-up did not show recurrence in any patient. These results suggest that azithromycin can be a good therapeutic option for the treatment of cutaneous leishmaniasis caused by Leishmania Viannia brasiliensis.

Histoplasmose em pacientes imunodeprimidos: estudo de 18 casos observados em Uberlândia, MG

The authors describe eighteen cases of histoplasmosis in immunodepressed patients, 17 with the acquired immunodeficiency syndrome (AIDS) and one patient with hepatic cirrhosis. The diagnosis of histoplasmosis was made by isolation of Histoplasma capsulatum from cerebrospinal fluid (CSF), blood and bone marrow or by histopathologic (biopsy or post mortem) examination. The mean age of the patients was 35.8 years; 13 patients were male (72.2%). The disease was disseminated, with the following distribution:skin (38.8%), bone marrow (27.7%), nasopharyngeal mucosa (22.2%), lungs (22.2%), colon (11.1%), central nervous system (5.5%) and esophagus (5.5%). Adenomegaly (50%), hepatomegaly (77.7%) and splenomegaly (61.1%) were frequently seen. The most common hematologic abnormality was pancytopenia (33.3%) of the patients. Eleven patients were treated, 9 with amphotericin B and 2 with itraconazole. Eight had good clinical improvement and all of them were given amphotericin B or a triazolic as maintenance therapy. This study emphasize the importance of this mycosis in imunodepressed patients, specially AIDS patients, in whom the infection tends to invade the macrophagic-lymphoid system and preferentially the cutaneous tegument.

Carcinoma basocelular - Análise de 300 casos observados em Uberlândia - MG

BACKGROUND: Basal cell Carcinoma is the most common type of skin cancer and represents 75% of malignant epithelial tumors. It usually occurs on the face of white individuals aged over 40 years, with history of repetitive exposure to sunlight OBJECTIVE: To describe the epidemiological data, clinical presentation and histopathological findings of 300 patients with basal cell carcinoma. CASUISTIC: A cross-sectional study of 300 patients with Basal cell Carcinoma seen at the outpatient Dermatology clinic from 1999 to 2003. Information was obtained on identification, exposure to sunlight and characterization of Basal cell Carcinoma. RESULTS: The pathological examinations confirmed the clinical diagnoses of 447 tumor lesions of 300 patients. Most patients were female (59.3%), white (93%), had exposure to sunlight (90.3%), with a single lesion (74%), involving predominantly the face (77% of the lesions). The most frequent pathological type was nodular carcinoma (46.3% of the lesions) and the superficial type predominated on the trunk. CONCLUSIONS: There was a predominance of female patients showing the current tendency of Basal cell Carcinoma. The presence of several successive or simultaneous tumors in the same patient emphasizes the importance of periodical exams in these patients. No exact correlation between exact clinical and pathological findings was established. The superficial type was confirmed as more frequent on the trunk.

Anatomia patológica de corações de chagásicos assintomáticos falecidos de modo violento

Com finalidade de melhor conhecimento da forma indeterminada da doenca de Chagas os autores realizaram estudo anatomopatologico sistematizado de trinta coracoes de chagasicos assintomaticos falecidos de modo violento. Demonstram que nos portadores da forma em questao da tripanossomiase cruzi o coracao e acometido por lesoes da mesma natureza, porem de intensidade muito menor do que as observadas em chagasicos cronicos que falecem subitamente ou apos periodo variavel de insuficiencia cardiaca. Baseados em seus achados e em outros dados da literatura, concluem que a infeccao chagasica, sem inflamacao do coracao, se ocorre, e rara. Tecem ainda consideracoes a respeito do significado das lesoes observadas no sistema nervoso autonomo intracardiaco no sistema de conducao e sobre a genese formal da cardite chagasica cronica humana.

Meningoencefalites toxoplásmica e chagásica em pacientes com infecção pelo vírus da imunodeficiência humana: diagnóstico diferencial anatomopatológico e tomográfico

Twenty-two HIV+ patients with encephalitis were studied. Of these, 7 had meningoencephalitis due to Toxoplasma gondii (MT) and 15 due to Trypanosoma cruzi (MC). Pathologic and computerized axial tomography (CAT) changes were compared. We found that focal necrotizing encephalitis due to Toxoplasma involved the cerebral cortex and the basal ganglia, whereas lesions due to Trypanosoma cruzi were centered in the white matter, sometimes extending into the cortex. Hemorrhages, myelin lesions and organisms were more pronounced in chagasic than in toxoplasmic encephalitis. These findings are consistent with the literature reviewed.Twenty-two HIV+ patients with encephalitis were studied. Of these, 7 had meningoencephalitis due to Toxoplasma gondii (MT) and 15 due to Trypanosoma cruzi (MC). Pathologic and computerized axial tomography (CAT) changes were compared. We found that focal necrotizing encephalitis due to Toxoplasma involved the cerebral cortex and the basal ganglia, whereas lesions due to Trypanosoma cruzi were centered in the white matter, sometimes extending into the cortex. Hemorrhages, myelin lesions and organisms were more pronounced in chagasic than in toxoplasmic encephalitis. These findings are consistent with the literature reviewed.

Ocorrência de cisticercose em necropsias realizadas em Uberlândia, Minas Gerais, Brasil

3937 autopsies were performed between 1971 and 1993 in the Servico de Anatomia Patologica of the Hospital de Clinicas of the Fundacao de Assistencia, Estudo e Pesquisa de Uberlândia, Universidade Federal de Uberlândia, in Minas Gerais, Brazil. At this Service of Pathology are realized all the autopsies of the municipal district of Uberlândia. The analysis of 2862 concluded autopsy reports, of death above the age of one year, disclosed 39 cases (1.4%) of cysticercosis. The age range was 16 to 83 years and 66.6% were males; 82.1 % of the patients were from Minas Gerais State, 15.4% were from Goias State, and in one case (2.5%) the origin was not registered. From these 39 cases, 35 (89.7%) showed central nervous system involvement, isolated or in association to other clinical forms of the disease; in 9 occurred the isolated or associated cardiac form; in 4 the muscular form, isolated or associated, was found; 4 presented the isolated or associated visceral form. In only 7 (17.9%) cases, the cysticercosis was assumed to be the direct cause of the death.

Corno cutâneo: estudo histopatológico retrospectivo de 222 casos

FUNDAMENTOS: O corno cutâneo e lesao acentuadamente hiperqueratotica, conica e circunscrita, que pode ocultar tanto lesoes benignas como malignas. OBJETIVO: Identificar histopatologicamente as principais dermatoses que se apresentam clinicamente como corno cutâneo. METODOS: Estudo histopatologico retrospectivo de 222 cornos cutâneos, a partir de laudos anatomopatologicos do Hospital de Clinicas de Uberlândia entre os anos de 1990 e 2006. RESULTADOS: A media de idade dos pacientes foi de 67,42 anos. O sexo feminino foi mais acometido (64,86%). O tempo medio de evolucao foi de 16,92 meses. As localizacoes mais frequentes das lesoes foram: cabeca (35,14%) e membros superiores (31,08%). Observaram-se lesoes histopatologicamente benignas em 41,44% e lesoes premalignas ou malignas em 58,56% dos cornos cutâneos estudados. Entre as lesoes pre-malignas, a queratose actinica foi encontrada em 83,84% dos casos; entre as malignas, o carcinoma espinocelular correspondeu a 93,75% dos casos. CONCLUSOES: Este estudo mostrou que a maioria dos cornos cutâneos surgiu sobre areas do corpo expostas a luz solar, predominantemente, cabeca e membros superiores. Considerando-se a elevada frequencia de lesoes premalignas e tambem a presenca de lesoes malignas, sugere-se exerese cirurgica seguida de estudo histopatologico dos cornos cutâneos, para confirmacao de diagnostico especifico.BACKGROUND Cutaneous horn is a keratotic, conical and circumscribed lesion that can hide both benign or malignant lesions. OBJECTIVE To identify,from a histopathological point of view, the main clinical dermatoses that are presented ,from a clinical point of view, as cutaneous horn. METHODS RETROSPECTIVE HISTOPATHOLOGICAL STUDY OF 222 CASES OF CUTANEOUS HORNS THAT WERE CLASSIFIED AS SUCH BY ANATOMICAL-PATHOLOGICAL REPORTS OF THE UNIVERSITY HOSPITAL (HOSPITAL DE CLINICAS DE UBERLANDIA) FROM 1990 TO 2006. RESULTS The average age of patients was 67,42. The female sex was more affected (64,86%). The average time of clinical evolution was 16,92 months. Lesions were mostly frequent located on the head (35,14%) and upper limbs (31,08%). Histopathological analysis considered 41,44 % of the lesions as benign and 58,56% as pre-malignant or malignant among the 222 cases of cutaneous horns studied. Within the group of pre-malignant lesions, actinic keratosis was found in 83,84% of the cases; within the group of malignant lesions, squamous cell carcinoma was found in 93,75% of the cases. CONCLUSIONS This study showed that the majority of cutaneosus horns occured in areas of the body that are exposed to the sun, predominantly head and upper limbs. Considering the high frequency of pre-malignant lesions and also the presence of malignant lesions it is suggested surgical exeresis followed by histopathological study of the cutaneous horns for confirmation of specific diagnosis.

Imaging Trypanosoma cruzi within tissues from chagasic patients using confocal microscopy with monoclonal antibodies.

Abstract Confocal fluorescence microscopy combined with differential interference contrast imaging of tissues from chagasic patients enabled the unequivocal identification of the parasite Trypanosoma cruzi. Using different monoclonal antibodies that indicate the parasite form and replication stage in conjunction with DNA labelling, specimens derived from distinct clinical forms of the disease were examined. Intracellular amastigote forms of the parasite were clearly detected in heart, brain, skin, lung, and kidney. Dividing amastigotes as well as trypomastigote forms were recognized in samples obtained from patients undergoing either acute-phase or some form of reactivation caused by immunosuppression.

Agreement between premortem and postmortem diagnoses in patients with acquired immunodeficiency syndrome observed at a brazilian teaching hospital

Acquired immunodeficiency syndrome (AIDS) is one of the main causes of death in adults worldwide. More commonly than in the general population, in patients with AIDS there is substantial disagreement between causes of death which are clinically suspected and those established by postmortem examination. The findings of 52 postmortem examinations were compared to the premortem (clinical) diagnoses, and there was 46% agreement between them. Fifty two percent of the patients had more than one postmortem diagnosis, and 48% had at least one AIDS-related disease not suspected clinically. Cytomegalovirus infection was the commonest (30.7%) autopsy finding, but not a single case had been suspected premortem. Bacterial infection, tuberculosis, and histoplasmosis were also common, sometimes not previously suspected, postmortem findings. This study shows that multiple infections occur simultaneously in AIDS patients, and that many among them are never suspected before the postmortem examination. These findings suggest that an aggressive investigation of infections and cancers should be done in patients with AIDS, particularly in those who do not respond to therapy of an already recognized condition.

Hantavirus pulmonary syndrome in Brazil: clinical aspects of three new cases

Hantavirus pulmonary syndrome (HPS) has been recognized recently in Brazil, where 28 cases have been reported as of September 1999. We report here the clinical and laboratory findings of three cases whose diagnoses were confirmed serologically. All the patients were adults who presented a febrile illness with respiratory symptoms that progressed to respiratory failure that required artificial ventilation in two of them. Laboratory findings were most of the time consistent with those reported in the United States in patients infected with the Sin Nombre virus, and included elevated hematocrit and thrombocytopenia; presence of atypical lymphocytes was observed in one patient. The chest radiological findings observed in all the patients were bilateral, diffuse, reticulonodular infiltrates. Two patients died. Histopathological examination of the lungs of these patients revealed interstitial and alveolar edema, alveolar hemorrhage, and mild interstitial pneumonia characterized by infiltrate of immunoblasts and mononuclear cells. In the epidemiologic investigation of one of the cases, serologic (ELISA) tests were positive in 3 (25%) out of 12 individuals who shared the same environmental exposure. HPS should be included in the differential diagnosis of interstitial pneumonia progressing to acute respiratory failure.