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Tuberculosis cutánea: reporte de dos casos y revisión de la literatura

Cutaneous tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis. It is uncommon (1% of all cases of tuberculosis), but has increased due to the human immunodeficiency virus epidemic and to pharmacologic immunosuppression. It presents a wide variety of clinical forms depending on how bacteria reach the skin and on the immune status of the patient. We present two cases of cutaneous tuberculosis diagnosed in the Hospital Clinico de la Pontificia Universidad Catolica de Chile. We emphasize the difficulty in diagnosis and classification of this disease and briefly discuss on the different diagnostic and therapeutic approaches.

Caracterización de especies del género Malassezia en pacientes con dermitis seborreica y en controles

Background: The yeast Malassezia spp has an established etiological role in pityriasis versicolor, folliculitis, systemic infections and onychomycosis. Aim: To assess the presence of Malassezia spp in patients with seborrheic dermatitis (SD), to find a correlation between Malassezia spp count and the severity of the disease and to compare the prevalence of the different Malassezia species in SD patients and subjects without skin lesions. Patients and methods: Scrapings of the face from 81 patients with SD (69 males) and 79 subjects (54 males) without skin lesions were obtained for a direct microscope examination and yeast culture. Results: The yeast Malassezia was found in 76% of SD patients and in 82% of subjects without skin lesions. There was a positive correlation between the number of yeasts found on direct examination and the clinical severity of lesions in SD patients. Although this correlation was statistically significant (p=0.046), the degree of association (rho=0.22) was weak. Fifty Malassezia species were identified. M globosa was found in 67% of SD patients, followed by M furfur and M sympodialis, each present in 16.5% of the SD patients. In subjects without skin lesions, the most prevalent species were M globosa (77%), followed by M sympodialis (12%), M slooffiae (7%) and M furfur (4%). Conclusions: The presence of the yeast Malassezia is not associated with the presence of skin lesions (Rev Med Chile 2003; 131: 1295-300). (Key Words: Dermatitis, seborrheic; Malassezia; Yeasts)

Enfermedad de Hansen: Revisión a propósito de un caso

Leprosy is a granulomatous disease affecting the skin and peripheral nerves caused by Mycobacterium leprae. The range of clinical forms varying from tuberculoid to lepromatous leprosy results from variations in the cellular immune response to the mycobacterium. Despite available combined drug-therapy, it continues to be a significant public health problem, carrying a strong stigma. Although recently there has been no native cases in Chile, a few imported cases have been diagnosed. We present a 56-year-old man who had lived in Paraguay for 8 years, and presented with leprosy 6 years after returning to Chile. The biology of leprosy, clinical features of the disease, current diagnostic criteria and approaches to treatment are discussed.

Diagnóstico de la infección por Treponema pallidum en pacientes con sífilis temprana y neurosífilis mediante reacción de la polimerasa en cadena

Syphilis is a sexually transmitted disease caused by Treponema pallidum. The diagnosis is based mainly in clinical presentation and non-specific assays. PCR-based diagnosis has been suggested as an attractive alternative method. The aim of this study was the validation of a PCR-based test for the diagnosis of early syphilis (ES) and neurosyphilis (NS). Clinical samples of mucocutaneous lesions and cerebrospinal fluid (CSF) specimens from patients previously diagnosed for ES and NS respectively using an enlarged gold standard, were tested by PCR. The reaction was done using primers targeting the tpN47 gene. Twenty out of 21 mucocutaneous samples from patients diagnosed with ES were positive by PCR, with a clinical sensitivity of 95%. Four out of 8 CSF samples from patients previously diagnosed with NS were positive by PCR, with a clinical sensitivity of 50%. The clinical specificity for both ES and NS was 100%. The PCR sensitivity and specificity for mucocutaneous samples allowed us to implement this assay in our laboratory for routine diagnosis. Although the sensitivity of the PCR in CSF was low, it may be useful to support clinical diagnosis.

Aplicación de método molecular en la detección de Mycoplasma genitalium en hombres y en mujeres embarazadas

Mycoplasma genitalium es un patogeno oportunista del tracto genital. En el hombre es causa de uretritis, en tanto que en mujeres ha sido implicado en la etiologia de cervicitis y de enfermedad inflamatoria pelviana (EIP). El objetivo de este estudio fue determinar la prevalencia de M. genitalium en pacientes mas culinos con uretritis y en muestras vaginales de mujeres embarazadas. Se obtuvo muestras de secrecion uretral en 37 pacientes con uretritis y de muestras vaginales de 50 consecutivas mujeres embarazadas, determinandose la presencia de M. genitalium mediante reaccion de polimerasa en cadena (RPC). Las muestras de secrecion uretral fueron tambien evaluadas en busca de Chlamydia trachomatis, Neisseria gonorrhoeae y Ureaplasma sp en tanto que en las de origen vaginal se investigo la microbiota y presencia de micoplasmas de tipo genital. Veintitres casos fueron clasificados como uretritis no gonococcica (UNG) y 14 como enfermedad gonococcica. M. genitalium fue detectado en 3 de 23 (13,04%) varones con UNG; en dos casos asociado a Ureaplasma sp, y en un paciente como agente unico. C. trachomatis fue detectado en 7 pacientes con UNG y en uno con gonorrea. Ureaplasma sp fue aislado en 13 (35,1%) pacientes, 8 casos de UNG y en 5 con gonorrea. El microorganismo fue detectado tambien en 6 (15%) de 40 mujeres; en 5 casos en presencia de microbiota normal (score de Nugent 0-3), y en un caso en presencia de vaginosis bacteriana. Ureaplasma spp fue aislado en las seis muestras positivas. En conclusion, este estudio demuestra que M. genitalium debe ser tambien considerado en la etiologia de la UNG asi como en el tracto genital inferior en la mujer embarazada, en presencia de una microbiota vaginal normal

Manifestaciones cutáneas de amiloidosis sistémica como clave diagnóstica: Caso clínico

Systemic amyloidosis is a rare disease that can affect any organ. Its clinical manifestations are varied and nonspecific. The skin involvement of this disease is common and can be easily recognized on physical examination. We report a 57-year-old male presenting with a two years history of malaise, dyspnea and myalgias. On physical examination, ungueal dystrophy, orange pigmentation of eyelids with periocular petechiae and mild macroglossia were observed. Incisional biopsies of the eyelids, cheeks and hands were obtained. The pathological study demonstrated amyloid deposits. Since protein electrophoresis was normal, the diagnosis of AA amyloidosis was postulated