Eliezer Benchimol

Frequência de lesões sugestivas de toxoplasmose ocular em uma população rural do Estado do Rio de Janeiro

ABSTRACT To determine the prevalence of ocular toxoplasmosis among the general population of the district of Santa Rita de Cassia, Barra Mansa, State of Rio de Janeiro, a cross-sectional study on 1,071 individuals was performed. These subjects underwent serological tests (anti- Toxoplasma IgG and IgM) and physical and ophthalmological examinations. The diagnosis of presumed ocular toxoplasmosis was based on clinical and serological criteria and the appearance of the retinochoroidal lesion. The lesions were classified into three morphological types: 1. Limits marked with a halo of hyperpigmentation and an area of central chorioretinal atrophy; 2. Hypopigmented halo and hyperpigmented central area; and 3. Hyperpigmented or hypopigmented. The prevalence of healed lesions compatible with ocular toxoplasmosis was 3.8% among the general population and 5.8% among individuals who were seropositive for Toxoplasma gondii (65.9% of the individuals evaluated). Type-1 lesions (41.5%), female sex (68.3%), peripheral lesions (58.5%) and lesions smaller than three disc diameters predominated.

South American cutaneous Leishmaniasis of the eyelids: Report of five cases in Rio de Janeiro State, Brazil

PURPOSE To describe American cutaneous leishmaniasis of the eyelids and highlight the main clinical and diagnostic features of lesions, which are rare in this location. DESIGN Retrospective, noncomparative case series METHODS Leishmanin skin test, touch preparations, histopathologic analysis, and culture in appropriate media were used for clinical confirmation and parasitologic diagnosis. Positive cultures were identified by the iso-enzymes technique. All patients were treated with pentavalent antimony applied intramuscularly. RESULTS Leishmanin skin test was positive in all five patients. Touch preparations, histopathologic analysis, and culture were performed in four patients. Touch preparations were positive (presence of Leishmans bodies) in two patients; histopathologic analysis showed a granulomatous infiltrate in four patients and parasite was present in two patients; culture was positive in three patients, and in two the parasite was identified as Leishmania (Viannia) braziliensis. Therapy was effective for all patients. CONCLUSIONS Cutaneous leishmaniasis of the eyelids is uncommon in the Americas. The disease may present diagnostic difficulties when appearing in nonendemic areas. The clues for diagnosis are the clinical aspect of lesions, the epidemiologic data, and a positive Leishmanin skin test. Demonstration of parasite is not always possible. Pentavalent antimonial compounds are the therapy of choice. Formerly, transmission of leishmaniasis occurred only when humans penetrated forested areas and became an incidental host. Now, eyelid lesions are part of the changing pattern in the transmission of the disease. With the increase in ecotourism, these lesions may begin to be seen in air travelers returning to other parts of the world.

The autoimmune diseases of the eyes.

The eye is divided anatomically in three layers: an outer or fibrous layer (cornea/sclera), middle or vascular layer (uvea - iris, ciliary body, and choroid) and an inner or sensorineural layer (retina). They compose the several anatomic and functional layers that enable the immune protection of the eye. The first layer involves an intact anatomic border with the blood-ocular barrier and immunosuppressive neuropeptides in the native aqueous humor. The second layer trusts on the capability of the eye to reestablish an immunosuppressive micro-environment by activating latent TGF-β and reestablishing the anterior chamber-associated immune deviation. The third layer involves a mechanism that is not yet completely recognized, but that has the ability to overcome a predominantly Th1 intraocular immune response and to reestablish anterior chamber-associated immune deviation. Understanding the comprehensive mechanisms of these pathways, will lead to the development of new treatments strategies in order to prevent damage to the eye from persistent or exacerbated inflammation, directed at first to pathogens, but that may develop an autoimmune reaction.

Postnatal acquired toxoplasmosis patients in an infectious diseases reference center

Infection caused by Toxoplasma gondii, toxoplasmosis, is one of the most frequent zoonoses in the world; it normally affects both genders equally. Humans are one of several possible intermediate hosts, and the disease is oligosymptomatic in most cases. Vertical transmission is an important cause of fetal malformation and sequels in newborns. Approximately 10% of postnatal cases present multiple manifestations, ranging from low fever and mild lymphadenopathy to severe encephalitis. In moderate cases, lesions such as retinochoroiditis may emerge during acute infection or even years later. We analyzed 313 cases of toxoplasmosis from 1992 to 2004, including 261 acute cases. Most patients were women (68.1%), and 39% of these were pregnant. Among acute infection cases, 64.8% presented symptomatic disease; the most frequent manifestations were lymphadenomegaly (59.8%), fever (27.2%), headache (10.7%), asthenia (10%), weight loss (8.4%), myalgia (8%), retinochoroiditis (3.4%) and hepatosplenomegaly (1.5%). Although ocular lesions by T. gondii are well documented as a possible consequence of postnatal infection, two patients developed retinochoroiditis only two years after primary infection. This demonstrates the need for toxoplasmosis case surveillance, even long after acute manifestations.

Avaliação oftalmológica em hanseníase multibacilar

Objetivo: Determinar a frequencia e o tipo de comprometimento ocular em pacientes portadores de hanseniase no momento do diagnostico. Metodologia: O estudo foi realizado na Fundacao Oswaldo Cruz (Rio de Janeiro) e avalia 77 casos classificados como multibacilares. O exame oftalmologico foi realizado de acordo com o sistema de classificacao de discapacidades recomendado pela Organizacao Mundial de Saude. Resultados: Referiam queixas especificas 36,3%: dor e ardencia ocular, lacrimejamento e dificuldade para enxergar. Em 55,8% dos pacientes foram detectadas alteracoes oculares no exame oftalmologico. A diminuicao da sensibilidade da cornea, que predispoe a ulceracao e opacificacao, foi a alteracao mais frequente (29,3%). Conclusao: Os achados desta pesquisa demonstram a gravidade e a alta frequencia das lesoes oculares nos casos avaliados e alertam para a importância do exame oftalmologico como rotina em portadores de hanseniase multibacilar.

Blepharo-conjunctivitis due to leishmania (viannia) braziliensis cutaneous infection- Report of two cases in Rio de Janeiro, Brazil

are no current therapeutic options. The size and the scope of our article were limited by the nature of a retrospective chart review, which only allows analysis of followup that occurred within the defined time frame. Additional factors limiting the scope and length of the study included (1) the logistical and financial complexity involved in following up patients in two geographically separated states; (2) the differences in available equipment in the two institutions; and (3) the importance of sharing a potential new treatment with the ophthalmic community sooner rather than later. The retrospective chart review process was begun while the senior author was at the University of Florida, and because he moved from Florida to Massachusetts, the analysis was carried out in Massachusetts, and appropriate Institutional Review Board approval from the Massachusetts site was published in the article. The valproic acid treatment regimen analysed retrospectively in the charts of the seven patients is detailed in the article. Prospective follow-up was not carried out, nor is it allowed under the mandate of a retrospective chart review. To clarify, the treatment of patients with valproic acid has not been stopped for any of the patients who tolerated it well (most of the patients). Our retrospective chart review reported on in the BJO article captured a relatively short period for a slowly progressive condition such as RP, and we recognise that the most rigorous validation of a therapy will be a well-designed clinical trial. A prospective, multicentre, randomised, placebo-controlled clinical trial is in the final stages of preparation in the USA, and we will be registering this clinical trial very soon at the US clinical trials website, http://www.clinicaltrials.gov. On a separate note, as part of our current clinical practice in Massachusetts, several RP patients new to our practice have been treated with valproic acid; our clinical impressions of these new patients are similar to what was reported in our article. There is mounting evidence that valproic acid may have potent neuroprotective properties and have other beneficial effects, and we have an intensive programme of in vitro and in vivo experiments (including mice models of RP) under way. The results of our experiments in the context of retinal degenerative conditions have been reported at recent meetings. We are planning to submit these data as articles to peer-reviewed journals. Our work has been motivated by the spirit of translational research, with the goal of more quickly identifying a promising therapeutic approach and stimulating scientific interest and further research, based on preclinical data and unexpectedly positive vision function observed in a clinical setting. Repurposing drugs such as valproic acid, which have been shown to be safe, is an economical and time-efficient way to quickly bring new treatments to patients.The authors report two uncommon cases of chronic granulomatous blepharo-conjunctivitis as a recurrence of Leishmania (Viannia) braziliensis cutaneous leishmaniasis (CL). Patients were otherwise healthy immunocompetent adults, as revealed by a positive cutaneous delayed-type hypersensitivity (DTH) reaction to Leishmania-derived antigens and a typical cell-mediated immunity-induced granulomatous reaction that had effect on the control of parasite replication at the lesions. This rare cause of ocular involvement should be considered in areas where Leishmania is endemic.