Paulo Eduardo Neves Ferreira Velho

Amygdalae Calcifications Associated with Disease Duration in Lipoid Proteinosis

Objectives. To describe imaging findings of central nervous system involvement in patients with lipoid proteinosis. Methods. Patients with lipoid proteinosis followed in the dermatology and neurology departments of the State University of Campinas between 2002 and 2004 were evaluated using high‐resolution MRI and computerized tomography (CT). Results. We reviewed the charts of three patients (two women) with lipoid proteinosis with, ages ranging from 5 to 44 years. Symptomatic disease duration ranged from 2 to 39 years. MRI scans showed hypointense signal in FLAIR and T2 images in the amygdalae in two of three patients. Brain CT scans from two patients showed that MRI findings were calcifications. The calcification was more evident in patients with longer disease duration. Epilepsy was identified in one patient with longer disease duration. No other epileptogenic lesion was identified on MRI in this patient. Conclusion. Lipoid proteinosis is associated with bilateral amygdalae calcification. These findings were more evident in patients with longer disease duration. Epilepsy, when present, may be related to these calcifications. Patients with lipoid proteinosis should be followed with MRI/CT in order to identify these abnormalities.

Bartonella spp. Bacteremia in Blood Donors from Campinas, Brazil

Bartonella species are blood-borne, re-emerging organisms, capable of causing prolonged infection with diverse disease manifestations, from asymptomatic bacteremia to chronic debilitating disease and death. This pathogen can survive for over a month in stored blood. However, its prevalence among blood donors is unknown, and screening of blood supplies for this pathogen is not routinely performed. We investigated Bartonella spp. prevalence in 500 blood donors from Campinas, Brazil, based on a cross-sectional design. Blood samples were inoculated into an enrichment liquid growth medium and sub-inoculated onto blood agar. Liquid culture samples and Gram-negative isolates were tested using a genus specific ITS PCR with amplicons sequenced for species identification. Bartonella henselae and Bartonella quintana antibodies were assayed by indirect immunofluorescence. B. henselae was isolated from six donors (1.2%). Sixteen donors (3.2%) were Bartonella-PCR positive after culture in liquid or on solid media, with 15 donors infected with B. henselae and one donor infected with Bartonella clarridgeiae. Antibodies against B. henselae or B. quintana were found in 16% and 32% of 500 blood donors, respectively. Serology was not associated with infection, with only three of 16 Bartonella-infected subjects seropositive for B. henselae or B. quintana. Bartonella DNA was present in the bloodstream of approximately one out of 30 donors from a major blood bank in South America. Negative serology does not rule out Bartonella spp. infection in healthy subjects. Using a combination of liquid and solid cultures, PCR, and DNA sequencing, this study documents for the first time that Bartonella spp. bacteremia occurs in asymptomatic blood donors. Our findings support further evaluation of Bartonella spp. transmission which can occur through blood transfusions.

Bartonella henselae Infects Human Erythrocytes

Bartonella henselae, a facultative intracellular bacterium, has been known as the agent of cat scratch disease, bacillary angiomatosis, peliosis hepatis, endocarditis, and bacteremic syndrome in humans. Bartonella species can cause intraerythrocytic infections and have been isolated from the bloodstream of patients by several methods. It was demonstrated that B. bacilliformis and B. quintana infect human endothelial cells and human erythrocytes and B. henselae infects erythrocytes of cats. The aim of this study was to investigate through transmission electron microscopy whether B. henselae infects mature human erythrocytes. One red blood cell (RBC) unit received an experimentally standard strain of B. henselae. Blood aliquots were collected from the infected unit immediately after inoculation, at 30 min and 1, 5, 10, and 72 h for ultrastructural evaluation. B. henselae was seen adhering to human erythrocytes 10 h after inoculation and inside the erythrocyte after 72 h. This study demonstrates that B. henselae adheres to and invades mature human erythrocytes. The results favor the possibility that erythrocytes can serve as a primary target in Bartonella spp. infections. From this observation, further studies are warranted to prevent Bartonella spp. transfusional transmission.

Severe Anemia, Panserositis, and Cryptogenic Hepatitis in an HIV Patient Infected with Bartonella henselae

Bartonella spp. constitute emerging pathogens of worldwide distribution. Bacillary angiomatosis is the most frequent skin manifestation of bartonelloses; nevertheless, B. henselae infection should always be considered systemic, especially in immunodeficient individuals. The authors report the case of an AIDS patient with bacillary angiomatosis, who had concurrent severe anemia, hepatitis, peritonitis, pleuritis, and pericarditis. Clinical manifestation, electronic microscopic examination of erythrocytes, and histopathology of a papule biopsy suggested a Bartonella sp. infection. Multiple genes were target by PCR and B. henselae DNA was amplified and sequenced (GenBank accession number EF196804) from the angiomatous papule. Treatment with clarithromycin resulted in resolution of the bacillary angiomatosis, fever, anemia, panserosites, and hepatitis.

Subcutaneous and cerebral cysticercosis

Cysticercosis is a human infestation, which is considered the most common cause of seizures worldwide. The subcutaneous lesions can help in the diagnosis of neurocysticercosis. We describe a case of a 45-year-old patient with multiple cutaneous nodules first seen 2 years ago that were increasing in number, and normal neurologic and fundoscopic examination. Neurologic symptoms started 3 months before hospital admission as a mild headache and muscular weakness. The imaging examinations showed a massive central nervous system involvement. Physicians must be aware of the importance of subcutaneous nodule examination for the diagnosis of neurocysticercosis.

What do we (not) know about the human bartonelloses

The human bartonelloses are a group of diseases with a rapidly increasing clinical spectrum. Well known manifestations such as Carrions disease, trench fever, cat-scratch disease, and bacillary angiomatosis are examples of Bartonella sp. infection. Along with these diseases, recurrent bacteremia, endocarditis, septicemia, erythema nodosum, erythema multiforme, trombocytopenic purpura and other syndromes have been reported having been caused by bacteria of this genus. The infectious process and the pathogenesis of these microorganisms are poorly understood. The bartonelloses may have a benign and self-limited evolution in a host, or a potentially fatal one. These bacteria can provoke a granulomatous or an angioproliferative histopathologic response. As these diseases are not yet well defined, we have reviewed the four main human bartonelloses and have examined unclear points about these emergent diseases.

Mesotherapy: a bibliographical review

Intradermotherapy is a medical procedure introduced by Pistor in 1958 that consists in the application of intradermal injections of diluted pharmacological substances that are given directly into the region to be treated. There are reports of the use of intradermotherapy to treat painful diseases, skin diseases and unaesthetic conditions. Medical clinics have been recently offering the treatment of intradermotherapy, using the more popular name for this practice - mesotherapy. There is only scant scientific information about this subject published in periodicals indexed on MedLine. Only a few states rigorously pursue this method. Most indexed publications about this subject deal with the complications of this technique. Unaesthetic dermatoses have been a common complaint in dermatologic clinics, and it has become necessary to have scientific evidence to give to patients. Therefore, well-researched scientific studies about this technique are necessary to offer data to medical professionals that will clearly explain to patients both the benefits and the risks of these procedures. A bibliographical review was conducted and we verified the need for new studies with adequate methods to confirm the benefits of intradermotherapy as used in dermatologic treatment.A intradermoterapia e um procedimento medico introduzido por Pistor, em 1958, e consiste na aplicacao, diretamente na regiao a ser tratada, de injecoes intradermicas de substâncias farmacologicas muito diluidas. Esse metodo e capaz de estimular o tecido que recebe os medicamentos tanto pela acao da punctura quanto pela acao dos farmacos, e apregoa-se que sua vantagem e evitar o uso de medicacao sistemica. Ha relatos da utilizacao da intradermoterapia para tratamento de doencas dolorosas, dermatoses e condicoes consideradas inesteticas. Atualmente, clinicas medicas oferecem esse tratamento, utilizando, porem, o nome mais popular para essa pratica, mesoterapia. Ha escassa informacao cientifica sobre o tema publicada em periodicos indexados no MedLine e poucos estudos com metodologia mais rigorosa sobre a eficacia e o mecanismo de acao da via intradermica. A maioria das publicacoes indexadas sobre esse tema versa sobre as complicacoes dessa tecnica. As dermatoses inesteticas tem se tornado queixas frequentes nos consultorios dermatologicos, sendo necessario um embasamento cientifico para lidar com tais pacientes, os quais, muitas vezes, estao em busca das novidades mostradas atraves da midia. Assim, ha necessidade de estudos cientificamente bem conduzidos sobre essa tecnica. Estes estudos deverao oferecer aos medicos elementos para esclarecer os pacientes sobre quais beneficios esperar e quais os riscos de tal abordagem. Desse modo, realizou-se uma revisao bibliografica sobre o assunto e constatou-se a necessidade de novos estudos com metodologia adequada para a confirmacao dos beneficios da intradermoterapia como ferramenta util no tratamento dermatologico.

Larva migrans: a case report and review

A case of massive Ancylostoma sp. larval infestation is presented in a patient who had received systemic corticosteroid therapy. What attracts attention in this case is the exuberance and rarity of clinical manifestation. Based on the pertinent literature, we discuss the mechanisms of parasital infection, the natural history of the disease and its treatment.

Prevalência de dermatoses na rede básica de saúde de Campinas, São Paulo - Brasil

BACKGROUND: Skin lesions are often noted by the individuals bearing them, as well as by their relatives. There is a significant number of patients with skin complaints who search for medical care. OBJECTIVES: To determine the frequency of dermatological complaints and/or findings in users of the primary health care system of the city of Campinas, Brazil. METHODS: Five units were chosen by the Municipal Health Department to participate in this research. All the patients assisted by health professionals of these units were evaluated regarding the presence or absence of dermatological symptoms/ signals in a time period of twenty working days. RESULTS: The acquired data demonstrated that 358 (24.01%) out of 1,491 assisted patients displayed dermatological complaints and/or findings, with a greater prevalence among the younger patients. Of all the users assisted by health professionals who participated in the study and had their records adequately filled out, 9.98% sought the primary care unit primarily because of a dermatological complaint. CONCLUSIONS: These results, in accordance to those of similar surveys carried out in other countries, show the importance of the specialty for the performance of non-dermatologist physicians, pediatricians in particular, and provide elements for the discussion surrounding the curricular reform, concerning the amount of time dedicated to the teaching of dermatology.

Morphine promotes renal pathology in sickle mice

Patients with sickle cell disease (SCD) are often treated with opioids for severe pain. Although opioids are known to have renal-specific effects, their role in nephropathy in SCD remains unknown. Because a subset of patients receives opioids for long periods of time, we examined the influence of chronic morphine treatment on mice with pre-existing renal disease expressing varying amounts of sickle hemoglobin. Morphine treatment for 3–6 weeks resulted in a variety of defects in renal morphology observed using light and electron microscopy. Notably, morphine induced glomerular pathology, resulting in increased glomerular volume, mesangial expansion, mesangial cell proliferation, parietal cell metaplasia, podocyte effacement, and microvillus transformation. Cystic tubulopathy and hemeoxygenase-1 expression and activity were also increased in morphine-treated mice. Naloxone, a non-selective opioid receptor (OR) antagonist, ameliorated these effects. Functionally, the urine albumin to creatinine ratio was increased following acute as well as chronic morphine treatment. These results suggest that clinically relevant doses of morphine induce renal pathology and that OR antagonists may be effective for ameliorating morphine-induced renal disease.