Carla Andréa Avelar Pires

Clinical, epidemiological, and therapeutic profile of dermatophytosis

BACKGROUND The cutaneous mycoses, mainly caused by dermatophyte fungi, are among the most common fungal infections worldwide. It is estimated that 10% to 15% of the population will be infected by a dermatophyte at some point in their lives, thus making this a group of diseases with great public health importance. OBJECTIVE To analyze the clinical, epidemiological, and therapeutic profile of dermatophytosis in patients enrolled at the Dermatology service of Universidade do Estado do Pará, Brazil, from July 2010 to September 2012. METHOD A total of 145 medical records of patients diagnosed with dermatophytosis were surveyed. Data were collected and subsequently recorded according to a protocol developed by the researchers. This protocol consisted of information regarding epidemiological and clinical aspects of the disease and the therapy employed. RESULTS The main clinical form of dermatophyte infection was onychomycosis, followed by tinea corporis, tinea pedis, and tinea capitis. Furthermore, the female population and the age group of 51 to 60 years were the most affected. Regarding therapy, there was a preference for treatments that combine topical and systemic drugs, and the most widely used drugs were fluconazole (systemic) and ciclopirox olamine (topical). CONCLUSION This study showed the importance of recurrent analysis of the epidemiological profile of dermatophytosis to enable correct therapeutic and preventive management of these conditions, which have significant clinical consequences, with chronic, difficult-totreat lesions that can decrease patient quality of life and cause disfigurement.

Perfil dos cuidadores e as dificuldades enfrentadas no cuidado ao idoso, em Ananindeua, PA

OBJETIVO: Descrever o perfil dos cuidadores de idoso, bem como sua importância e principais dificuldades no ato de cuidar do idoso. METODOLOGIA: Trata-se de estudo transversal descritivo e exploratorio realizado pela equipe PET Saude, em uma Estrategia de Saude da Familia (ESF), no municipio de Ananindeua, Para. A coleta de dados foi feita por meio de um questionario semiestruturado abordando aspectos sociodemograficos e questoes referentes a importância e dificuldades encontradas pelos cuidadores de idosos. RESULTADOS: Foram entrevistados 31 cuidadores, predominando sexo feminino, estado civil casado, com ensino medio completo, renda entre dois e tres salarios minimos, tempo de exercicio da funcao maior que 12 meses, em sua abrangencia cuidadores informais e com vinculo de parentesco com o idoso. Os cuidadores reconheceram que e importante a presenca de um cuidador e consideraram o idoso sob seu cuidado como saudavel. CONCLUSAO: A maioria dos cuidadores era do tipo informal, caracterizada por mulheres, com vinculo familiar, que destacaram a paciencia e a falta de conhecimento como as principais dificuldades do cuidador. Os dados deste estudo se limitam a uma realidade local, necessitando de mais pesquisas para fomentar as particularidades e dificuldades enfrentadas pelos cuidadores.

Clinical, epidemiological and mycological report on 65 patients from the Eastern Amazon region with chromoblastomycosis

BACKGROUND Chromoblastomycosis is a chronic fungal infection caused by fungi from the Dematiaceae family. According to several studies, Fonsecaea pedrosoi is the most common of these fungi. The infection is more common in tropical countries, with the Brazilian state of Pará having one of the largest infected populations worldwide. The disease is difficult to treat and recurrences are common. OBJECTIVES To describe the epidemiological and mycological aspects of cases of chromoblastomycosis and its clinical forms in the state of Pará, Brazil. METHODS Mycological exams (direct mycological examinations, culture and microculture) were performed and a clinical/epidemiological evaluation was made of 65 patients receiving care at the Dermatology Department of the Federal University of Pará between 2000 and 2007. The clinical classification proposed by Carrión in 1950 was used in this study. RESULTS The majority of the patients were male (93.8%), agricultural workers (89.2%) of 45 to 55 years of age, and the majority of lesions (55.4%) were of the verrucous type, located principally on the lower limbs (81.5%). In the majority of the cases investigated (61.5%), the infection had been present for a long time, with a mean duration of 11 years. Direct mycological examination was performed in 86.2% of the patients (n=56). Of these, 96.4% (n=54) tested positive. Culture and microculture were performed in vitro in 47 cases of those that tested positive at direct microscopy, results showing Fonsecaea pedrosoi to be the only agent present in this sample. CONCLUSION This study highlighted the extent to which chromoblastomycosis still affects the quality of life of the local population, principally individuals working in agriculture. This is a chronic disease for which there is no effective treatment. The importance of continuing to investigate this disease should be emphasized, as further studies may lead to new clinical or epidemiological findings.

Evaluation of cases of pemphigus vulgaris and pemphigus foliaceus from a reference service in Pará state, Brazil

BACKGROUND Pemphigusis a bullous, rare and chronic autoimmune disease. There are two major forms of pemphigus: vulgaris and foliaceus. Epidemiological data and clinical outcome in patients diagnosed in the Brazilian Amazon states are still rare. OBJECTIVES To study the occurrence of the disease during the study period and analyze the epidemiological profile of patients, the most common subtype of pemphigus, and the clinical evolution of patients. METHODS Retrospective analysis of medical records of hospitalized patients with pemphigus foliaceus and pemphigus vulgaris in the period from 2003 to 2010 in Dermatology Service of Hospital Fundação Santa Casa de Misericórdia do Pará, Belém, Northern Brazil. RESULTS We found a total of 20 cases of pemphigus during the study period, 8 of which were of foliaceus pemphigus and 12 of vulgaris pemphigus. Pemphigus foliaceus had the predominance of male patients (75%), showed satisfactory clinical evolution, and was characterized by absence of pediatric cases. Pemphigus vulgaris affected more women (66.7%), showed mean hospital stay of 1 to 3 months (50%), and there were three cases of death (25%). The prescribed immunosuppressive drugs included prednisone with or without combination of azathioprine and/or dapsone. Sepsis was associated with 100% of the deaths. CONCLUSIONS The occurrence of the disease is rare, there are no familiar/endemic outbreaks in the sample. Evolution is usually favorable, but secondary infection is associated with worse prognosis. The choice of best drugs to treat pemphigus remains controversial.

Hanseníase em menores de 15 anos: a importância do exame de contato

OBJETIVO: Describir dos casos de enfermedad de Hansen en menores de 15 anos, siendo uno de paciente con 18 meses de edad y otro de 13 anos, diagnosticados por modos de deteccion distintos, subrayando la importancia de examinar a los contactos. DESCRIPCION DEL CASO: Uno de los casos tuvo diagnostico temprano mediante examen de contactos intradomiciliares, mientras que el otro fue diagnosticado por demanda espontanea despues de cuatro anos de surgimiento de las lesiones y, a pesar de ser contacto de un ex-paciente, no fue examinado en la epoca. COMENTARIOS: En paises endemicos, la alta deteccion de enfermedad de Hansen en menores de 15 anos revela la persistencia en la transmision del bacilo y las dificultades de los programas de salud para el control de la enfermedad. El mayor tiempo para diagnostico ocasiona secuelas y deformidades y, de ese modo, la busqueda por los contactos constituye importante metodo para el diagnostico temprano de la enfermedad en la infancia, cuando las senales clinicas no siempre son faciles de identificarse y hay gran diversidad de formas clinicas en que la enfermedad puede presentarse.ABSTRACT Objective : To describe two cases of leprosy in children un-der 15 years old, being one patient aged with 18 months and other 13 years, diagnosed by different modes of detection, emphasizing the importance of examining the contacts. Case description : One of the cases was diagnosed early by examining household contacts, while the other was diag-nosed by spontaneous demand, after four years of the onset of lesions, although he had been a former patient contact who was not examined at the time. Comments : In endemic countries, the high detection of leprosy in children under 15 years old reveals the persistence of the bacillus transmission and the difficulties encountered by public health programs to control the disease. Delay in leprosy diagnosis leads to sequels and deformities and, thus, the search for contacts is important as an effective method for early diagnosis of the disease in childhood, where clinical signs are not always easy to be identified due to the great variety of clinical forms in which the disease may occur.

Leprosy Reactions in Patients Coinfected with HIV: Clinical Aspects and Outcomes in Two Comparative Cohorts in the Amazon Region, Brazil

Background Leprosy, caused by Mycobacterium leprae, can lead to scarring and deformities. Human immunodeficiency virus (HIV), a lymphotropic virus with high rates of replication, leads to cell death in various stages of infection. These diseases have major social and quality of life costs, and although the relevance of their comorbidity is recognized, several aspects are still not fully understood. Methodology/Principal Findings Two cohorts of patients with leprosy in an endemic region of the Amazon were observed. We compared 40 patients with leprosy and HIV (Group 1) and 107 leprosy patients with no comorbidity (Group 2) for a minimum of 2 years. Group 1 predominantly experienced the paucibacillary classification, accounting for 70% of cases, whereas Group 2 primarily experienced the multibacillary classification (80.4% of cases). There was no significant difference in the prevalence of leprosy reactions among the two groups (37.5% for Group 1 vs. 56.1% for Group 2), and the most frequent reaction was Type 1. The appearance of Group 1 patients’ reversal reaction skin lesions was consistent with each clinical form: typically erythematous and infiltrated, with similar progression as those patients without HIV, which responded to prednisone. Patients in both groups primarily experienced a single episode (73.3% in Group 1 and 75% in Group 2), and Group 1 had shorter reaction periods (≤3 months; 93.3%), moderate severity (80%), with 93.3% of the patients in the state of acquired immune deficiency syndrome, and 46.7% presenting the reaction at the time of the immune reconstitution inflammatory syndrome. Conclusions/Significance This study used a large sample and makes a significant contribution to the clinical outcomes of patients in the reactive state with comorbid HIV and leprosy. The data indicate that these diseases, although concurrent, have independent courses.

Comparison between histopathologic features of leprosy in reaction lesions in HIV coinfected and non-coinfected patients*

BACKGROUND Leprosy and HIV are diseases that have a major impact on public health in Brazil. Patients coinfected with both diseases, appear to be at higher risk to develop leprosy reactions. OBJECTIVE The aim of this study is to describe the histopathological aspects of cutaneous lesions during reactional states in a group of patients with HIV-leprosy coinfection, compared to patients with leprosy, without coinfection. METHODS Two groups were established: group 1 comprised of 40 patients coinfected with HIV-leprosy; group 2, comprised of 107 patients with leprosy only. Patients presenting reactional states of leprosy had their lesions biopsied and comparatively evaluated. RESULTS Reversal reaction was the most frequent feature in both groups, with dermis edema as the most common histopathological finding. Giant cells were seen in all group 1 histopathological examinations. Dermis edema was the most common finding in patients with erythema nodosum leprosum. CONCLUSION Few histopathological differences were found in both groups, with reversal reaction as the most significant one, although this fact should be analyzed considering the predominant BT clinical form in the coinfected group and BB form in the group without HIV. Larger prospective studies in patients with HIV-leprosy coinfection are needed to confirm and broaden these results.

Epidermólise bolhosa distrófica pruriginosa: relato de caso

A epidermolise bolhosa distrofica pruriginosa e doenca genetica rara cujo padrao de heranca ainda nao esta bem estabelecido na literatura. O defeito genetico, que envolve a codificacao do colageno tipo VII, esta localizado no braco curto do cromossomo 3, ocorrendo mutacao no gene COL7A1. Apresenta-se o caso de um paciente do sexo masculino que referia prurido nas pernas ha cerca de 15 anos, cujo diagnostico foi firmado com base nos exames dermatologico e imuno-histopatologico. Devido a raridade dessa condicao patologica, realiza-se breve revisao do tema.

Tufted angioma in ear auricle: importance of the differential diagnosis

Tufted angioma is an acquired vascular proliferation with specific histological characteristics. The most common clinical features are erythematous macules. It occurs predominantly in children and young adults, especially in the chest and neck. We report the case of a male patient, 12 years old, with an increased right ear auricle associated with erythematous macules and increased local temperature, referred with a diagnosis of lepromatous leprosy; however, this diagnosis was questioned. Histopathology was consistent with tufted angioma.

Leprosy in children under 15 years: the importance of early diagnosis

OBJETIVO: Describir dos casos de enfermedad de Hansen en menores de 15 anos, siendo uno de paciente con 18 meses de edad y otro de 13 anos, diagnosticados por modos de deteccion distintos, subrayando la importancia de examinar a los contactos. DESCRIPCION DEL CASO: Uno de los casos tuvo diagnostico temprano mediante examen de contactos intradomiciliares, mientras que el otro fue diagnosticado por demanda espontanea despues de cuatro anos de surgimiento de las lesiones y, a pesar de ser contacto de un ex-paciente, no fue examinado en la epoca. COMENTARIOS: En paises endemicos, la alta deteccion de enfermedad de Hansen en menores de 15 anos revela la persistencia en la transmision del bacilo y las dificultades de los programas de salud para el control de la enfermedad. El mayor tiempo para diagnostico ocasiona secuelas y deformidades y, de ese modo, la busqueda por los contactos constituye importante metodo para el diagnostico temprano de la enfermedad en la infancia, cuando las senales clinicas no siempre son faciles de identificarse y hay gran diversidad de formas clinicas en que la enfermedad puede presentarse.ABSTRACT Objective : To describe two cases of leprosy in children un-der 15 years old, being one patient aged with 18 months and other 13 years, diagnosed by different modes of detection, emphasizing the importance of examining the contacts. Case description : One of the cases was diagnosed early by examining household contacts, while the other was diag-nosed by spontaneous demand, after four years of the onset of lesions, although he had been a former patient contact who was not examined at the time. Comments : In endemic countries, the high detection of leprosy in children under 15 years old reveals the persistence of the bacillus transmission and the difficulties encountered by public health programs to control the disease. Delay in leprosy diagnosis leads to sequels and deformities and, thus, the search for contacts is important as an effective method for early diagnosis of the disease in childhood, where clinical signs are not always easy to be identified due to the great variety of clinical forms in which the disease may occur.