Ana Maria Roselino

CD4+CD25+ T Cells in Skin Lesions of Patients with Cutaneous Leishmaniasis Exhibit Phenotypic and Functional Characteristics of Natural Regulatory T Cells

Endogenous regulatory T (Treg) cells are involved in the control of infections, including Leishmania infection in mice. Leishmania viannia braziliensis is the main etiologic agent of cutaneous leishmaniasis (CL) in Brazil, and it is also responsible for the more severe mucocutaneous form. Here, we investigated the possible involvement of Treg cells in the control of the immune response in human skin lesions caused by L. viannia braziliensis infection. We show that functional Treg cells can be found in skin lesions of patients with CL. These cells express phenotypic markers of Treg cells--such as CD25, cytotoxic T lymphocyte-associated antigen 4, Foxp3, and glucocorticoid-induced tumor necrosis factor receptor--and are able to produce large amounts of interleukin-10 and transforming growth factor- beta . Furthermore, CD4+CD25+ T cells derived from the skin lesions of 4 of 6 patients with CL significantly suppressed in vitro the phytohemagglutinin-induced proliferative T cell responses of allogeneic peripheral-blood mononuclear cells (PBMCs) from healthy control subjects at a ratio of 1 Treg cell to 10 allogeneic PBMCs. These findings suggest that functional Treg cells accumulate at sites of Leishmania infection in humans and possibly contribute to the local control of effector T cell functions.

Comparison of the specificity of PCR and the histopathological detection of leishmania for the diagnosis of American cutaneous leishmaniasis

More precise and rapid diagnostic methods for American cutaneous leishmaniasis (ACL) are necessary because of the growing number of cases observed in Brazil, including the northeastern region of the State of São Paulo. We applied PCR to 54 skin or mucosal biopsies from patients with a clinical and/or laboratory diagnosis of ACL using primers 13A and 13B, with positive results being obtained for 82% of the samples. When the PCR results were compared to those of histopathological leishmania detection, PCR showed superior results with 81.5% sensitivity and 95% CI of 68.0-95.1%. The Montenegro skin test (MST) was positive in 88.7% of patients. Since MST cannot be used as a diagnostic tool in endemic areas, the present results strongly suggest the use of PCR for the etiological confirmation of ACL, with emphasis on the mucosal form.

Porphyria cutanea tarda in Brazilian patients: association with hemochromatosis C282Y mutation and hepatitis C virus infection

OBJECTIVE:Porphyria cutanea tarda (PCT) is commonly associated with iron overload and hepatitis C virus (HCV) infection. Association between hemochromatosis C282Y or H63D mutations and PCT has been observed, although not uniformly, and iron overload is also commonly found in chronic HCV hepatitis. The aim of the present study was to investigate the frequency of C282Y and H63D mutations and HCV infection in Brazilian patients with PCT and their relationship with iron overload.METHODS:Twenty-three patients (19 men) aged 39.6 ± 11.1 yr were studied. All had dermatological lesions of PCT and high levels of urinary uroporphyrin. HCV infection and iron overload were investigated. DNA samples were analyzed for the presence of HFE mutations.RESULTS:The frequency of C282Y was significantly higher in PCT patients than in 278 healthy individuals (17.4% vs 4%, odds ratio = 5.1, 95% confidence interval 1.5–17.6, p= 0.02), whereas no difference was observed regarding the H63D mutation (30.4% vs 31%, odds ratio = 1, 95% confidence interval 0.4–2.4, p= 1). Biochemical tests in PCT patients showed iron overload with transferrin saturation = 47.3 ± 20.7% and ferritin = 566.8 ± 425 ng/ml. Fifteen of 23 (65.2%) patients had HCV infection and alcohol ingestion was observed in 17 of 23 (73.9%).CONCLUSIONS:PCT patients exhibited evidence of iron overload, a high frequency of HCV, and an association with C282Y mutation. These data further support the notion that both acquired and inherited factors contribute to the occurrence of PCT, and indicate that screening for C282Y may be justified in PCT patients.

Dermatoses among Brazilian HIV-positive patients: correlation with the evolutionary phases of AIDS

Background The presence of dermatoses is very common in Acquired Human Immunodeficiency Syndrome (AIDS). The present study was undertaken to correlate the various dermatoses with the evolutionary phases of AIDS.

NEPHROTOXICITY ATTRIBUTED TO MEGLUMINE ANTIMONIATE (GLUCANTIME) IN THE TREATMENT OF GENERALIZED CUTANEOUS LEISHMANIASIS

BACKGROUND Pentavalent antimonials have became of basic importance for the treatment of leishmaniasis. Their most severe side effects have been reported to be increased hepatic enzyme levels and electrocardiographic abnormalities. Nephrotoxicity has been rarely related. OBSERVATIONS We report a case of generalized cutaneous leishmaniasis involving a 50-year old male patient who was submitted to treatment with meglumine antimoniate (Glucantime). He developed acute renal failure (ARF) due to acute tubular necrosis (ATN), followed by death after receiving a total of 53 ampoules of Glucantime. CONCLUSIONS The treatment with Glucantime was responsible by ARF diagnosed in this patient. The previous urine osmolarity and serum creatinine levels were normal and the autopsy showed ATN. It should be pointed out if ARF may also be explained by massive deposits of immunocomplexes by leishmania antibodies and antigens due to the antigenic break by the antimonial compound, since our patient presented countless lesions covering the entire tegument, similar to the Hexheimer phenomenon, but at the autopsy no glomerular alterations were seen.

Endemic Pemphigus foliaceus ("Fogo selvagem"): a series from the Northeastern region of the State of São Paulo, Brazil, 1973-1998

UNLABELLED Endemic Pemphigus Foliaceus (EPF) is a bullous autoimmune skin disease whose incidence used to be high in the State of São Paulo (SP), Brazil, during the forties, but has declined thereafter. OBJECTIVES to report a series of EPF patients from the northeastern region of SP. METHODS a retrospective study concerning demographic and epidemiological data of patients seen from 1973 to 1998 was conducted at the University Hospital, Faculty of Medicine of Ribeirão Preto, SP. RESULTS bullous disease was diagnosed in 340 patients, 245 with EPF (72.1%), 9.4 cases per year, 60.4% females, and 70.2% white, 7 to 82 year-old (29.4% in their teens); 46.9% lived in the rural zone. Concerning profession, housewives predominated among women (67.6%) and agricultural workers among men (40.2%). The time of disease was less than 1 year in 62.0% of cases, followed by 1 and 5 years (27%), and more than 5 years for the remaining patients (11%). 36.7% of patients were referred by the Direção Regional de Saúde (DIR) XVIII of Ribeirão Preto, with the largest number of cases being from Ribeirão Preto and Batatais: 33.3% and 23.3%, respectively; 22% from DIR XIII (Franca); 13.5% from DIR VII (Araraquara); 2.9% from DIR IX (Barretos); 4.1% from other DIRs of SP, and 20.8% from other States (16.7% from Minas Gerais). Thirteen (5.3%) patients reported occurrence of the disease in some relative, and 4 (1.6%) in neighbors. CONCLUSIONS the present data characterize the northeastern region of the state of São Paulo as a remaining endemic focus of EPF.

Generalized cutaneous leishmaniasis in acquired immunodeficiency syndrome

BACKGROUND Leishmaniasis associated with HIV/AIDS has been reported in the last decade. CASE REPORT A case of generalized cutaneous leishmaniasis in a patient with AIDS is described. The case is paradoxical in that the cutaneous lesions resemble anergic leishmaniasis caused by Leishmania (L.) amazonensis and Jorge Lobos disease, but the positive Montenegro test and the clinical improvement with antimonial are more commonly observed in leishmaniasis caused by L.(V.) braziliensis. COMMENT The immunosuppression due to HIV/AIDS seen in this patient may explain the dissemination of the lesions, but the positive specific response to leishmanial antigen may explain the good response to the antimonial treatment.

Color image processing and content-based image retrieval techniques for the analysis of dermatological lesions

This paper presents color image processing methods for the analysis of dermatological images in the context of a content-based image retrieval (CBIR) system. Tests were conducted on the classification of tissue components in skin lesions, in terms of necrotic tissue, fibrin, granulation, and mixed composition. The images were classified based on color components by an expert dermatologist following a black-yellow-red model. Indexing and retrieval of images were performed based on texture information obtained from the red, green, blue, hue, and saturation components of the color images. The performance of the CBIR system was measured in terms of precision and recall. Initial results demonstrate the potential of the proposed methods with the best precision result of 70% obtained for the characterization of mixed tissue composition.

Histoplasmosis in individuals with acquired immunodeficiency syndrome (AIDS): Report of six cases with cutaneous-mucosal involvement

The authors report the first six cases of disseminated histoplasmosis and acquired immunodeficiency syndrome (AIDS) seen at the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, from 1987 to 1989, with emphasis on dermatological clinical manifestations, nasal mucosa lesions and treatment. The mycosis was the first manifestation of AIDS in four patients. It is concluded that biopsies of the lesions for histopathologic study and fungal culture are important for diagnosis.

Incidência do pênfigo vulgar ultrapassa a do pênfigo foliáceo em região endêmica para pênfigo foliáceo: análise de série histórica de 21 anos

FUNDAMENTO: Ha dois tipos principais de penfigo: penfigo vulgar e penfigo foliaceo. Nos ultimos anos, mudancas clinicas e epidemiologicas relacionadas aos penfigos tem sido observadas. OBJETIVOS: Teve-se por objetivo analisar uma serie historica de 21 anos de casos de penfigo vulgar e penfigo foliaceo no nordeste do estado de Sao Paulo, area endemica para o penfigo foliaceo. METODOS: Neste estudo descritivo, foram analisados os dados relacionados a incidencia anual e a idade de inicio do quadro clinico compativel com penfigo vulgar ou penfigo foliaceo, no periodo de 1988 a 2008, comparando-se ambas as formas de penfigo. RESULTADOS: O conjunto dos resultados abrange um periodo de 21 anos, com 103 casos de penfigo vulgar e 163 casos de penfigo foliaceo. A comparacao das linhas de tendencia em relacao a incidencia mostrou ser esta decrescente para o penfigo foliaceo em comparacao aquela de crescimento para o penfigo vulgar. Houve variacao ampla nas faixas de idade, com persistencia da faixa minima de 10 a 20 anos para o penfigo foliaceo (media de idade de 32,1 anos), e clara tendencia de diminuicao da idade minima para o penfigo vulgar (media de idade de 41,5 anos), principalmente a partir da metade da primeira decada do periodo total analisado. CONCLUSOES: A incidencia do penfigo vulgar ultrapassa aquela do penfigo foliaceo a partir de 1998, permanecendo assim ate os dias de hoje. Esta serie historica de 21 anos vem consubstanciar a modificacao da epidemiologia dos penfigos no Brasil, suscitando novas hipoteses para a sua etiopatogenese.