Mário A. P. Moraes

Histopatologia da leishmaniose tegumentar por Leishmania braziliensis braziliensis: 1. Padrões histopatológicos e estudo evolutivo das lesões

The Authors describe the histopathological findings observed in biopsies from 378 cases of Mucocutaneous Leishmaniasis, caused by Leishmania braziliensis braziliensis. All the patients lived in the locality of Tres Bracos, State of Bahia, an endemic area of Leishmaniasis in Brazil. Parasites were found in 63.7% of patients with cutaneous form and in 35.7% of cases with mucous lesions, although always in reduced number. Histopathologic findings allowed the caracterization of five different patterns: 1. Exsudative-cellular reaction, due to infiltraction of histiocytes, lymphocytes and plasm cells; 2. Exsudative-necrotic reaction, characterized by the association of necrosis with cellular infiltration; 3. Exsudative and necrotic-granulomatous reaction, corresponding to pattern described as chronic-granulomatous inflammation with necrosis; 4. Exsudativegranulomatous reaction, characterized a disorganized granulomatous reaction, without tissue necrosis; 5. Exsudative-tuberculoid reaction — in which a typical tuberculoid granuloma is formed. The follow-up study in 49 patients showed, in sucessive biopsies, changes in the histopathologic patterns in 63.2% of cutaneous forms and in 45.4% of the mucous forms. It was concluded that the exsudative-cellular reaction represents both the inicial and final pattern of Mucocutaneous Leishmaniasis lesion. The other four histopathologic patterns characterize intermediate forms found during the evolution of the disease.

Simulium species of the amazonicum group as vectors of Mansonella ozzardi in the Brazilian Amazon.

Experimental infection with Mansonella ozzardi of common haematophagous Diptera collected at a Ticuna Indian village on the upper reaches of the Solimões river in the Brazilian Amazon, showed that Simulium amazonicum and Simulium n.sp. are capable of supporting full development of the parasite. Natural infections with this filaria were found in both species including infective larvae in Simulium n.sp. No development of M. ozzardi occurred in Mansonia amazonensis, Culicoides insinuatus or Lepiselaga crassipes (Tabanidae). The dimensions of developing larvae of M. ozzardi in both species of black-fly were recorded. Infective larvae of this species may easily be distinguished from those of Onchocerca volvulus, also transmitted in the Amazon by a species closely resembling S. amazonicum, by the presence of a bifid tail and higher anal ratio in M. ozzardi.

The status of Simulium oyapockense and S.limbatum as vectors of human onchocerciasis in Brazilian Amazonia

Abstract. In an attempt to explain trie current distribution of onchocerciasis in the forests of northern Brazil (Moraes etal., 1979,1986), and its potential for dispersal to other areas, this study compares the vector status of Simulium oyapockense Floch and Abonnenc, 1946 in both a hypoendemic and an onchocerciasis free area with that of S.limbatum Knab, 1915 in the latter area. Both species allowed the full development of Onchocerca volvulus (Leuckart) to the infective L3 stage after experimental infection with microfilariae. Their vector competence was significantly lower than for other efficient vector species in South America and Africa because of the lethal effect of the cibarial armature on ingested microfilariae. The low vector capacity of S. oyapockense, together with the low prevalence and intensity of infection of O. volvulus, probably explains why onchocerciasis has not significantly increased in intensity over the last 10 years in the hypoendemic part of the Amazonian focus. Omnipresence of both vector species in the adjacent savanna region, however, could facilitate the spread of onchocerciasis if human population movements continue from the hyperendemic part of the onchocerciasis focus.

Caso fatal de adiaspiromicose pulmonar humana

A fatal case of human pulmonary adiaspiromycosis is reported. The patient, a male farm laborer from Pernambuco, in the Northeastern part of Brazil, had moved to Planaltina, DF., one year prior the onset of his illness. The main clinical manifestations consisted in fever, myalgia, cough and dyspnea. After being sick for five weeks, the patient developed severe respiratory failure and died. Grossly, disseminated nodular lesions, a few millimeters in diameter, were observed throughout the lobes of both lungs. Microscopically, round structures, up to 600 /mi in diameter, with a thick membrane, identified as adiaconidia of Chrysosporium parvum var. crescens, were seen in the center of the nodular lesions. These adiaconidia appeared predominantly inside microabscesses or necrotic areas, both surrounded by a granulomatous reaction. The pulmonary alveoli not affected by the nodular lesions contained an inflammatory exudate composed of macrophages and neutrophils. The finding of several non-fatal cases of the disease in the area of the Federal District suggests that adiaspiromycosis is endemic in the Central Brazilian Plateau region, where the dry, warm and windy climate, particulary from August to October, may provide the appropriate environmental conditions for the dissemination of C. parvum conidia.

Infecção pulmonar fatal por Lagochilascaris sp., provavelmente Lagochilascaris minor Leiper, 1909

A fatal case of pulmonary infection with Lagochilascaris sp. — probably Lagochilascaris minor — is presented. A 18-year-old girl from Curralinho — State of Para developed a severe pneumonitis of unknown origin, and died less than three months after the onset of the illness, She was admitted to the Hospital, in Belem-Para, on 16 June 1983, with fever, productive cough, dyspnea and, eventually, cyanosis. At that time, she had been sick for at least four or five weeks. A chest X-ray film taken shortly after admission disclosed extensive bilateral infiltrates, predominantly on the right lung. Acid-fast bacilli and fungi, however, could not be demonstrated in the sputum. The leucocyte count was low (3.900), with 60% neutrophils and 40% lymphocytes. In spite of several therapeutic schedules (no definite cause for the disease could be found) the patients condition rapidly deteriorated. She persisted with fever, cough, expectoration of thick sputum, dyspnea and cyanosis, but other symptoms also came forth: hoarseness, fatigue, weight loss and labored breathing. On 13 July she developed respiratory insufficiency and died. At autopsy, the lungs appeared distended with numerous areas of consolidation; the cut surface, when exposed, revealed disseminated foci, both nodular and diffuse, of granulomatous and exsudative inflammation. Microscopically, sections of eggs and round worms were found in the preparations, always surrounded by granulomas or large areas of necrotic tissue. The worms were recognized as evolutive stages — larvae, adult males and a gravid female — of a nematode belonging to the genus Lagochilascaris, probably Lagochilascaris minor. The identification was based, mainly, on the aspect of the eggs, which exhibited the irregular-shaped, saucerlike depressions or pits, characteristic of the genus. The female worm had lateral alae and the uterus full with similar eggs. In all 25 cases of human lagochilascariasis so far described, the location of the lesions was in the region of neck, ear, mastoid process, orbit, paranasal sinuses and retropharyngeal tissues. For the first time, the present case, a member of the genus Lagochilascaris is referred to in a different site of the host. Besides that, the finding of eggs, larvae and adult worms in the lung tissues strongly suggests the existence of a pulmonary cycle in human lagochilascariasis.

New records of Mansonella ozzardi: a parasite that is spreading from the state of Amazonas to previously uninfected areas of the state of Acre in the Purus River region

Mansonella ozzardi infections are common in the riverside communities along the Solimões, Negro and Purus Rivers in the state of Amazonas (AM). However, little is known about the presence of this parasite in communities located in regions bordering AM and the state of Acre. The prevalence rate of M. ozzardi infections was determined in blood samples from volunteers according to the Knott method. A total of 355 volunteers from six riverine communities were enrolled in the study and 65 (18.3%) were found to be infected with M. ozzardi. As expected, most of the infections (25%) occurred in individuals involved in agriculture, cattle rearing and fishing and an age/sex group analysis revealed that the prevalence increased beginning in the 40-50-years-of-age group and reached 33% in both sexes in individuals over 50 years of age. Based on the described symptomatology, articular pain and headache were found to be significantly higher among infected individuals (56 and 65% prevalence, respectively, p < 0.05). Sera from volunteers were subjected to ELISA using a cocktail of recombinant proteins from Onchocerca volvulus to evaluate the specificity of the test in an endemic M. ozzardi region. No cross-reactions between M. ozzardi-infected individuals and recombinant O. volvulus proteins were detected, thus providing information on the secure use of this particular cocktail in areas where these parasites are sympatric.

Human lagochilascariasis: about three cases found in the Federal District, Brazil

Three new cases of human infection with Lagochilascaris minor are reported. All the patients were from the state of Pará (Brazil), living in rural areas or close to the forest. They were admitted to hospitals in the Federal District due to the presence of abscesses in the region of the neck, ear, mastoid process and, in two of them, to the involvement also of the central nervous system. Microscopic examination of tissue samples taken from the lesions showed sections of eggs and worms--in different evolutive stages--identified as Lagochilascaris minor. Larvae and adult worms obtained from existing fistulae proved also to be of the same species. The three patients were treated with anthelmintic drugs and surgical excision of the lesions, with good clinical results. In two of them, however, relapsing occurred, suggesting that the drugs do not destroy the worm eggs, in spite of the apparent healing of the lesions.Three new cases of human infection with Lagochilascaris minor are reported. All the patients were from the State of Para (Brazil), living in rural areas or close to the forest. They were admitted to hospitals in the Federal District due to the presence of abscesses in the region of the neck, ear, mastoid process and, in two of them, to the involvement also of the central nervous system. Microscopic examination of tissue samples taken from the lesions showed sections of eggs and worms - in different evolutive stages - identified as Lagochilascaris minor. Larvae and adult worms obtained from existing fistulae proved also to be of the same species. The three patients were treated with autihelmintic drugs and surgical excision of the lesions, with good clinical results. In two of them, however, relapsing occurred, suggesting that the drugs do not destroy the worm eggs, in spite of the apparent healing of the lesions.

Histopatologia da leishmaniose tegumentar por Leishmania braziliensis braziliensis. 4. Classificação histopatológica

The Authors have analysed the histopathological alterations observed in 162 cases of Mucocutaneous Leishmaniasis from Tres Bracos, Bahia, of whom 131 (80,9%) had purely cutaneous lesions and 31 (19,1%) had only mucosal lesions. The clinical behavior of 5 histopathological forms was documented in relation to treatment. The best prognosis was associated with the exudative granulomatous histopathology, a phase where the a host mechanism to use the parasite is evident leading to necrosis and granuloma formation as a residual sign. Therapy in this phase merely hastened the process. In a further large group the lesions were classified as exudative cellular reaction (cutaneous forms), an exudative necrotic reaction and an exudative necrotic gra- nulomatous reaction. In these cases the mechanisms of host defense are still being developed and the effect of therapy is to reduce the time to healing. Cutaneous cases with an exudative tuberculoid reaction had a worse prognosis, although there was a favourable response to treatment if the patient was young, the lesion was of short duration and the intradermal leishmanin test was not exaggerated Lastly are a group of mucosal cases with an exudative cellular reaction where this infiltrate may be a manifestation of auto agression. These cases, also classified as exudative tuberculoid, occur in adult patients with longstanding lesions and an exaggerated leishmanin skin test. They have a poor prognosis. This study develops suggestions for a classification based on the histopathological picture which could be valuable in predicting prognosis and influencing the choice of treatment. This classification is strictly morphological and is easy for the pathologist to apply. It appears to, correspond to the clinical course of the illness and could aid the clinician in the initial case evaluation.

Case report of subcutaneous entomophthoromycosis with retroperitoneal invasion

The authors describe a case of entomophthoromycosis in a previously healthy patient, who presented with an abscess in the right buttock. After surgical drainage it evolved into a retroperitoneal tumor. The patient improved clinically after resection of the mass and ketoconazole treatment. The histopathological analysis showed the Splendore-Hoeppli phenomenon, suggesting Basidiobolus ranarum infection, a zygomycosis generally restricted to the subcutaneous tissue, with rare gastrointestinal involvement.

Adiaspiromicose pulmonar humana novo caso da forma disseminada

A case of disseminated pulmonary form of adiaspiromycosis is reported. This is the second case of the disease found in Brasilia, DF. The patient, a 42-year-old peasant, lived in Corrente - State of Piaui, where he certainly acquired the infection. He was admitted to the Social Security Hospital, in Brasilia, with fever, chills, dry cough and dyspnea. At that time, he had been sick for about ten months and the decision of seeking medical care in Brasilia resulted from an exacerbation of the symptoms that had occurred two months before. At a right thoracotomy for a lung biopsy, disseminated white nodular lesions, a few millimeters in diameter, could be observed on the lung surface. Microscopically, round structures, 300 microns or more in diameter, identified as adiaconidia of Chrysosporium parvum var. crescens were seen in the center of some of these lesions. The tisssue response to the causative agent consisted of microabscesses, surrounded by cells in palisading arrangement, and granulomas of the mixed and foreign body types. The two kinds of lesions were thought to represent evolutive stages of the inflammatory process, and to be related to different exposures to the conidia, on separated occasions. The suppurative lesions would be recent lesions, started some weeks or a few months before, while the others, in which the granulomatous reaction predominated, were possibly older lesions, with an evolutions of at least several months.