Luiz Carlos Cucé

Treatment of Paracoccidioidomycosis, Candidiasis, Chromomycosis, Lobomycosis, and Mycetoma with Ketoconazole

ABSTRACT: The authors present the use of ketoconazole in 27 cases of paracoccidioidomycosis, eight of mycetoma, seven of chromomycosis. four of systemic candidiasis and one of lobomycosis. The drug was administered orally in a dosage of 200 to 400 mg per day within a period of up to 90 days. The results of the treatment for paracoccidioidomycosis were of cicatrization of the cutaneous lesions in three to four weeks in 24 patients and in two, from six to seven weeks. Out of 27 patients, 14 presented pulmonary lesions. The evolution within a 90‐day period showed radiological cure in one case, improvement in seven, and unaltered picture in five patients. In one there was no further control. In the three out of four cases of candidiasis there was clinical and mycological cure and in one case marked improvement. In seven cases of chromomycosis there was marked improvement in two moderate in four, and slight in one case. There was slight improvement in one case of lobomycosis, and in eight cases of mycetoma moderate improvement in three, slight in three and none in two, but the mycological examinations wore still positive. The drug tolerance was excellent.

PERIODONTAL ASPECTS OF THE JUVENILE FORM OF PARACOCCIDIOIDOMYCOSIS

Three cases of the juvenile form of paracoccidioidomycosis are reported. Emphasis has been given to the oral manifestations, particularly the periodontal involvement. The main periodontal findings were: generalized and progressive alveolar bone destruction leading to gingival recession with exposure of the tooth roots, and spontaneous tooth losses. The gingival mucosa was predominantly smooth, erythematous and slightly swollen. These aspects, although rare, may be the earliest signs of the disease and sometimes its only manifestations.

Entomoftoromicose rinofacial por Conidiobolus coronatus: registro de um caso tratado com sucesso pelo fluconazol

A case of rhinofacial entomophthoromycosis caused by Conidiobolus coronatus is reported in a 30 years old male from Sao Paulo, Brazil. The patient was successfully treated with oral fluconazole in a prolonged regimen. The diagnosis was confirmed by histopathological and mycological data.

Disseminate Sporotrichosis - Report of a Clinical Case with Mucocutaneous, Osteo-Articular, and Ocular Lesions*

Summary: This paper reports a case of disseminate sporotrichosis with cutaneous, mucous, osseous, and ocular lesions, a fact rarely registered in the literature, mainly because it happened in Brazil where this mycosis is frequent. The cutaneous and mucous lesions were severe, causing irreversible sequelae. Of special gravity was the ocular lesion resulting in blindness of the affected eye. The study showed no altered delayed immunity.

Feo-hifomicose subcutânea por Exophiala jeanselmei: registro de três casos em transplantados renais

We report three cases of subcutaneous phaeohy-phomycosis due to Exophiala jeanselmei (Langeron) McGinnis et Padhye 1977, in kidney transplant patients. Exophiala jeanselmei is a dematious fungus having also ability to rarely procedure eumycetoma (black grains). According to KWON-CHUNG & BENNETT (1992)27 such fungus is antigenically very heterogeneous, since so far three serotypes have been identified; each serotype including subgroups. Subcutaneous phaeohyphomycosis is becoming more and more frequent in kidney transplant patients submitted to an immunosupressive treatment. As Exophiala jeanselmei has already been isolated from the environment it becomes difficult to explain the pathogenicity of these cases by a reactivation of quiescent processes. The authors suggest an occasional fungistatic action of cyclosporine A upon Exophiala jeanselmei. A review of the literature was carried out with the report mainly of cases published in Brazil.

American tegumentary leishmaniasis: langerhans cells in montenegro skin test

This work analyzed the histopathology and epidermal Langerhans cells (LC) of Montenegro skin test (MST) in patients with American tegumentary leishmaniasis (ATL) in order to in situ characterize and compare the immunological reaction of the two major clinical forms of ATL, localized cutaneous leishmaniasis (LCL) and mucocutaneous leishmaniasis (MCL). MST histopathology of both LCL and MCL showed superficial and deep perivascular inflammatory infiltrate composed mainly of lymphocytes and histiocytes. Epidermal LC population was higher in MST biopsies taken from LCL patients when compared to MCL group, at 48 and 72 hours after antigen inoculation. Increased number of epidermal LC displayed in MST biopsies of LCL patients represents specific cellular immunity against parasites. The decrease of LC in MST biopsies of MCL patients does not necessarily indicate a worse specific cellular immunity in this clinical form of leishmaniasis.

Cytokine profile in Montenegro skin test of patients with localized cutaneous and mucocutaneous leishmaniasis

American tegumentary leishmaniasis presents as two major clinical forms: localized cutaneous leishmaniasis (LCL) and mucocutaneous leishmaniasis (MCL). The immune response in leishmaniasis is efficiently evaluated by the response to Leishmania antigen through the Montenegro skin test (MST). Both LCL and MCL present positive response to MST, indicating that the patients present cell-mediated immunity against the parasite - Leishmania. In spite of the presence of immunity in MCL, this is not sufficient to stop disease progression and prevent resistance to treatment. In this study we demonstrated interleukin (IL) 2, 4, 5 and interferon (IFN) gamma expression in biopsies of MST of ten patients with American tegumentary leishmaniasis. The obtained results were compared between LCL (n = 5) and MCL (n = 5) patients. The MST of MCL patients displayed a higher expression of IL-2, IL-4 and IL-5, in comparison to LCL. There was no significant difference in IFN-gamma expression between groups. The obtained results suggest the role of IL-4 and IL-5 in the maintenance of the immunopathogenic mechanism of the destructive lesions that characterize MCL.

Allergic reaction to botulinum toxin: positive intradermal test.

Botox (Allergan, Irvine, CA) was introduced in Brazil in 1992 for the treatment of hyperhidrosis and neurologic disorders, and in 2000 it was approved for cosmetic use. Each Botox vial contains 100 U of botulinum toxin (BTX), 0.9 mg of sodium chloride, and 0.5 mg of human albumin, and its protein load is 5 ng. Prosigne (Lanzhou Institute of Biological Products/Cristália, Lanzhou, China), each vial containing 50 or 100 U of BTX, was approved for the treatment of hyperhidrosis, neurologic disorders, and hyperfunctional lines in 2005. The excipients in Prosigne are 5 mg porcine gelatin (Haemacell), 25 mg of dextran, and 25 mg of sucrose, and the protein load is 4.0 to 5.0 ng/100 U of BTX.

Luz intensa pulsada no fotoenvelhecimento: avaliação clínica, histopatológica e imuno-histoquímica

BACKGROUND Intense pulsed light has been used in the treatment of photoaging without a full understanding of its mechanism of action. OBJECTIVE To study the effect of intense pulsed light on photoaging and on the skin immune response by means of a clinical and histopathological study, evaluating Langerhans cells (CD1), expression of intercellular adhesion molecule, of CD4 and CD8 lymphocytes and quantification of collagen and elastic fibers. METHODS In 2006 a total of 26 patients, aged 40 to 65 years, with phototypes II to III (Fitzpatrick scale), were treated for photoaging using intense pulsed light in five sessions with a monthly interval. All the patients were subjected to histological and immunohistochemical evaluation 6 months after treatment. RESULTS At the end of the treatment clinical improvement was observed in 76.92% of cases. This improvement was associated to a significant increase of collagen (51.33%) and elastic (44.13%) fibers. Intense pulsed light treatment led to a reduction of CD4 lymphocytes and did not alter the amount of CD8 lymphocytes. It also led to a significant increase of small, nonectatic blood vessels, positive intercellular adhesion molecule. CONCLUSION Facial treatment with intense pulsed light promoted major clinical improvement that was confirmed by histological examination of the skin. This technique is a good treatment option for skin photoaging because it is non-ablative, safe and effective.

Botulinum Toxin for the Treatment of Menopausal Hot Flushes: A Pilot Study

&NA; The botulinum toxin used in this study was provided by Laboratorio Biosintetica.