Juliane Gomes de Paula Amato

An Evaluation of clinical, serologic, anatomopathologic and immunohistochemical findings for fifteen patients with mucosal leishmaniasis before and after treatment

Treatment of mucosal leishmaniasis (ML) can be controlled by clinical examination and by serologic titers by the indirect immunofluorescence serologic reaction (IISR). We studied the correlation between the presence of antigen in tissue determined by immunohistochemistry, the IISR titers and the anatomopathologic findings in fifteen patients with ML before and after healing of the lesions as determined by otorhinolaryngologic evaluation, and evaluated these parameters to determine which of them could be useful during follow-up. Tissue antigens became negative in four patients (group A) after treatment, with a statistically significant reduction or negativity of IISR titers (p < 0.05). This did not occur in patients in whom the antigen persisted after treatment (group B), suggesting that serologic follow-up should be performed together with the search for tissue antigen, a combination which, to our knowledge, has not been used in previous studies. The negativity of tissue antigens and the behavior of IIRS titers in group A patients probably indicate a lower possibility of recurrence. Upon anatomopathologic examination the inflammatory process was found to persist after treatment even in group A, suggesting that the permanence of inflammatory activity even in clinically healed lesions is possibly correlated with the presence of the antigen or of some unknown factor.

Lesões cutâneas como únicas manifestações de reativação da infecção pelo Trypanosoma cruzi em receptora de rim por transplante

Paciente com doenca de Chagas, em fase cronica, apos ter sido submetida a transplante de rim sofreu reativacao da infeccao devido ao Trypanosoma cruzi, como consequencia de imunodepressao medicamentosa. O acontecimento manifestou-se exclusivamente atraves de lesoes cutâneas ulceradas, merecendo portanto divulgacao tal aspecto clinico inusitado.

Probable recognition of human anisakiasis in Brazil

In Japan, anisakiasis is frequent, due to the consumption of sushis and sashimis. It is also common in Holland, Scandinavia and along the Pacific coast of Latin America. In Brazil, there are no reports of this human infection, although studies have shown the existence of some contaminated fish. Dorado, anchovies, red porgy and swordfish have been cited, especially from the northeast region. Moreover, it is known that Anisakis physeteris and Pseudoterranova sp. have been found in the stomachs of Kogia breviceps whales, in Brazil, off the coast of Fernando de Noronha, indicating a new geographic distribution of this parasite. There are no reports of the existence of nematodes of the Anasakidae family in codfish gutted, dried and salted for commerce in the fishing industry of São Paulo State.

Ekbom syndrome (delusory parasitosis): ponderations on two cases

Two persons met one of us to ask for medical advice. On the basis of the clinical picture, we established the diagnosis of Ekbom syndrome, fundamentally related to skin lesions. We judged it relevant to communicate these occurrences, particularly for the reason that, in spite of our vast experience in dealing with clinical and assistance practice, we had not until now come into contact with patients in such situation. There is no doubt that this subject deserves specific commentaries, as it connotes speculation, doubts, and a wide range of opinions. The first account of a complex set of symptoms later known as the restless legs syndrome (anxietas tibiarum) was given in 1685 by Sir Thomas Brown, an English physician. The same investigator wrote a monograph under the title “Letter to a Friend” describing a condition observed in children of Languedoc, characterized by the periodic extrusion of stiff “black hairs” observed on their lumbar region. These children were called “morgellons” in the local language. Even now, such fundamental aspects of both conditions, as etiology, clinical picture and therapy, are the object of doubts. The symptoms of the restless legs syndrome are at first felt when the patient is at rest: an unpleasant sensation in the legs (rarely in the arms) accompanied by uncontrollable movements which become less intense when there is voluntary activity, to return when this activity ceases. Serious sleep disturbance results. Both syndromes: the restless legs (Wittmaak -– Ekbom) and the morgellons are now identified as two distinct entities, but there are some authors who still consider them as two aspects of the same entity because neuropsychiatric symptoms considered to be analogous can be observed in both cases. The persistence of such doubts is an indication of scarcity of information available about the causes of symptoms that, for lack of proper investigation, are inexplicable as to their origin and persist interfering with people’s normal daily activities. A better fate was not in prospect for those with morgellons disease. They sense the migration of mysterious “parasites” under their skin. Sometimes skin fragments together with structures defined as “fibers” are extruded. Such cases are often diagnosed as delusory parasitosis. As yet their etiology has not been defined. In the consultation room these patients describe the feeling that they have migrating parasites and, as evidence to prove their case, they bring for examination small boxes containing fragments of apparently normal skin in which can sometimes be found filaments which are not identified as pieces of cloth. The frequency of this occurrence led medical students to coin the expression “matchbox syndrome”. Atrocious suffering is associated with the presence of such “parasites”. Sometimes the diagnostic hypothesis of “larva migrans” is accepted and anthelminthic treatment is prescribed. On consulting a dermatologist, the patients are usually referred to a psychiatrist. The paucity of convincing information about their causes has led to the acceptance of the hypothesis that the symptoms of the morgellons disease are a manifestation of Lyme disease, even though no epidemiological or laboratory data confirm such diagnostic assumption. There is a tendency to judge the accounts of patients as illogical, resulting from neuropsychiatric problems which do not correspond to a true clinical picture. In view of such hypothesis, prophylactic measures against this syndrome would be pointless. A tendency has been recently observed to oppose the notion that the Wittmaack-Ekbom syndrome is exclusively the result of a neuropsychiatric disorder; various medical research institutions are showing interest in identifying its possible causative agents, devising new laboratory research techniques and eventually finding a suitable therapeutic project. Basic data concerning the two cases observed are specified below:

Aplicação de método de coloração tricrômica, em fezes diarréicas de infectados pelo HIV, para pesquisa de microsporídios

The microsporidia have been involved in several clinical manifestations in patients with AIDS, of whom diarrhoea is the commonest. The diagnosis of microsporidiasis depended on invasive procedures and the identification of the organisms is made by electron microscopy. The modified trichrome staining method allows that the diagnosis be made without such procedures by using light microscopy. In the present work, the modified trchrome method was applied in stools from 62 patients with diarrhoea, who had asymptomatic HIV infection or AIDS. Of the 62 samples analyzed, there was detection of microsporidial spores in one. This work confirms the existence of such protozoans in our patients, associated with manifestations of chronic diarrhoea in patients with AIDS who have severe immunodeficiency and ascertains that this staining method allows satisfactory identification of microsporidia from faeces, as well points out some directions to further studies.