RESUMEN
This paper aims to describe the histomorphologic features of skin biopsies of single lesion leprosy patients recruited at outpatient clinics in four Brazilian states in the Northeast (Amazonas and Rondonia), Southeast (Rio de Janeiro) and Center-West (Goiás) between October 1997 and December 1998. Patients clinically diagnosed as single skin lesion paucibacillary (SSL-PB) leprosy had a standard 4-mm punch biopsy taken from the lesion before rifampin, ofloxacin, minocycline (ROM) therapy. The features of the cellular inflammatory infiltrates, the presence of nerve involvement and acid-fast bacilli (AFB) were used to categorize SSL-PB biopsies into different histopathological groups. Two-hundred-seventy-eight (93.0%) out of 299 patients had a skin biopsy available. Seven single lesion patients were diagnosed as BL or LL leprosy types (MB) by the histopathological exams and 12 cases were excluded due to other skin diseases. Therefore, 259 patients had skin lesions with histomorphological features compatible with PB leprosy categorized as follows: 33.6% (N = 87) of the biopsies represented well-circumscribed epithelioid cell granuloma (Group 1); 21.6% (N = 56) less-circumscribed epithelioid cell granuloma (Group 2); 12.0% (N = 31) were described as mononuclear inflammatory infiltrate permeated with epithelioid cells (Group 3), and 29.7% (N = 77) had perivascular/periadnexal mononuclear inflammatory infiltrate (Group 4). Minimal/no morphological alteration in the skin was detected in only 8 (3.1%) SSL-PB patients categorized as Group 5, who were considered to have leprosy by clinical parameters. SSL-PB leprosy patients recruited in a multicentric study presented histomorphology readings comprising the whole PB leprosy spectrum but also a few MB cases. These results indicate heterogeneity among SSL-PB patients, with a predominance of well-circumscribed and less-circumscribed epithelioid cell granulomas (Groups 1 and 2) in the sites studied and the heterogeneity of local cellular immune response.
Asunto(s)
Lepra Lepromatosa/tratamiento farmacológico , Lepra Lepromatosa/patología , Mycobacterium leprae/crecimiento & desarrollo , Adulto , Antibacterianos/uso terapéutico , Antiinfecciosos/uso terapéutico , Biopsia , Estudios de Cohortes , Quimioterapia Combinada , Femenino , Histocitoquímica , Humanos , Leprostáticos/uso terapéutico , Masculino , Persona de Mediana Edad , Minociclina/uso terapéutico , Neuritis/patología , Ofloxacino/uso terapéutico , Rifampin/uso terapéuticoRESUMEN
This study was undertaken to assess whether the immunoperoxidase technique using anti-BCG serum is able to confirm the diagnosis of early leprosy among patients whose unique clinical manifestation is a localized area of sensory loss, in a higher proportion than the routine mycobacterial staining methods, namely hematoxylin-eosin and Wade. The study was held in the north of a hyper-endemic area of leprosy, Manaus, Amazonas (Brazil). Fifty-one paraffin-embedded skin biopsy blocks were retrieved and processed for the immunohistochemical study, by means of anti-BCG polyclonal antibodies for the detection of mycobacterial antigens. The routine stains confirmed the leprosy diagnosis in 17% of the cases, while the immunostaining method confirmed it in 47%. The McNemar test showed that the observed difference between these two techniques was statistically significant (p = < 0.05). In the same way, 50 blocks of skin conditions considered in the differential histopathological diagnosis of early leprosy were processed for the immunohistochemical test to analyze the possibility of false-positive results which occurred in 8 (16%) patients. The study suggests that immunostaining may increase the proportion of the routine histological diagnosis of leprosy in patients who have sensory loss only, even while using biopsies obtained in fieldwork conditions. This is very advantageous in hyper-endemic areas and in areas that are in the post-elimination period of leprosy control where sensory loss may be a sentinel sign of the disease.
Asunto(s)
Técnicas para Inmunoenzimas , Lepra/diagnóstico , Neuronas Aferentes/patología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Piel/microbiología , Adolescente , Adulto , Anciano , Animales , Anticuerpos Monoclonales/inmunología , Biopsia , Bovinos , Niño , Preescolar , Dermatitis/microbiología , Eosina Amarillenta-(YS) , Femenino , Hematoxilina , Humanos , Lactante , Lepra/microbiología , Lepra/fisiopatología , Masculino , Persona de Mediana Edad , Mycobacterium bovis/inmunología , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/microbiología , Piel/inervación , Piel/patologíaRESUMEN
Serum levels of soluble tumor necrosis factor alpha receptor I (sTNF-RI) were elevated in patients with lepromatous (LL) reactional-state type II leprosy, and sTNF-RII levels were increased in patients with full tuberculoid (TT) or LL type II leprosy. The sTNF-R in sera from patients with type II leprosy, but not other forms of leprosy, inhibited recombinant TNF cytolytic activities in vitro. This suggests that sTNF-R regulatory activities are partially impaired in patients with leprosy.
Asunto(s)
Antígenos CD/sangre , Lepra/sangre , Receptores del Factor de Necrosis Tumoral/sangre , Adulto , Animales , Antígenos CD/fisiología , Pruebas Inmunológicas de Citotoxicidad , Femenino , Humanos , Lepra/tratamiento farmacológico , Lepra/inmunología , Lepra Tuberculoide/sangre , Lepra Tuberculoide/tratamiento farmacológico , Lepra Tuberculoide/inmunología , Masculino , Ratones , Receptores del Factor de Necrosis Tumoral/fisiología , Receptores Tipo I de Factores de Necrosis Tumoral , Receptores Tipo II del Factor de Necrosis Tumoral , Solubilidad , Células Tumorales Cultivadas , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresRESUMEN
The authors present the first report of Leishmania (Viannia) guyanensis (L.(V.) guyanenesis) associated with human immunodeficiency virus (HIV) in a Brazilian heterosexual man. It is also the first case of HIV infection associated with American cutaneous leishmaniasis in Brazilian Western Amazonia. The patient had cutaneous and mucous lesions with a negative Montenegro skin test. Histopathology showed large numbers of amastigotes, even in a lesion which had clinically healed. L.(V.) guyanenesis was typed by an immunoenzymatic technique. Various therapies were attempted, but the patient relapsed after each episode of treatment.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Leishmania guyanensis/aislamiento & purificación , Leishmaniasis Mucocutánea/diagnóstico , Enfermedades Nasales/parasitología , Infecciones Oportunistas Relacionadas con el SIDA/parasitología , Infecciones Oportunistas Relacionadas con el SIDA/patología , Adulto , Animales , Brasil , Diagnóstico Diferencial , Humanos , Leishmaniasis Mucocutánea/parasitología , Leishmaniasis Mucocutánea/patología , Masculino , Enfermedades Nasales/diagnósticoAsunto(s)
Técnicos Medios en Salud , Antiinfecciosos/efectos adversos , Leprostáticos/efectos adversos , Lepra/tratamiento farmacológico , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/etiología , Antiinfecciosos/uso terapéutico , Brasil/epidemiología , Control de Enfermedades Transmisibles , Quimioterapia Combinada , Humanos , Leprostáticos/uso terapéutico , Lepra/epidemiología , Lepra/prevención & control , Organización Mundial de la SaludRESUMEN
The Montenegro skin test is widely used as a diagnostic method for American cutaneous leishmaniasis (ACL) but little is known about the histological changes that occur in the skin after administration of the antigen. This report is based on histological studies of biopsied material obtained, from inoculation sites, 48 hours after individuals had been given intradermal injections with a standardized Montenegro antigen. The material examined was obtained from four distinctly different test groups: naturally infected patients with parasitologically proved ACL and with positive Montenegro's reaction; individuals without previous history of ACL and not previously tested with Montenegro antigen; participants in anti-ACL vaccine trials who developed positive reactions to Montenegro antigen after vaccination; other participants in vaccine trials who had negative Montenegro responses after vaccination or had served as controls in the trials. The histological pictures of each group are described and discussed. Histologically, the reactions of vaccinated individuals were indistinguishable from those with naturally acquired infections.
Asunto(s)
Hipersensibilidad Tardía/patología , Leishmaniasis/diagnóstico , Pruebas Cutáneas/métodos , Humanos , Piel/patologíaRESUMEN
Patients with deep mycoses diagnosed in dermatologic clinics of Manaus (state of Amazonas, Brazil) were studied from November 1973 to December 1983. They came from the Brazilian states of Amazonas, Pará, Acre, and Rondônia and the Federal Territory of Roraima. All of these regions, with the exception of Pará, are situated in the western part of the Amazon Basin. The climatic conditions in this region are almost the same: tropical forest, high rainfall, and mean annual temperature of 26C. The deep mycoses diagnosed, in order of frequency, were Jorge Lobo's disease, paracoccidioidomycosis, chromomycosis, sporotrichosis, mycetoma, cryptococcosis, zygomycosis, and histoplasmosis.