RESUMEN
BACKGROUND: Onychomycosis is frequent in patients with late and advanced HIV disease; immunocompromised patients may develop atypical clinical presentations that can be difficult to control. Current treatment for onychomycosis is based on the prolonged administration of antifungal therapies that may have significant interactions with combined antiretroviral therapy (cART). An improvement in certain HIV-associated opportunistic infections has been associated with initiation of cART. OBJECTIVES: The aim of this study was to analyze the influence of cART on the outcome of onychomycosis in HIV-infected patients. METHODS: HIV-infected patients with dermatologic lesions attending the National Institute of Respiratory Diseases were asked to undergo physical examination. Detailed clinical histories were recorded. Routine laboratory tests, CD4 T cell count, and HIV viral load were performed. Onychomycosis was diagnosed on the basis of clinical appearance. Nail scrapings were collected from toenails and fingernails. Specimens were analyzed using direct microscopy. Nail changes after cART initiation were assessed by clinical examination. RESULTS: Improvement in onychomycosis was observed in six patients with late and advanced HIV disease after initiation of cART. Complete resolution of onychomycosis was observed in one patient without the use of antifungal therapy; one patient required topical antifungal treatment, and two patients required systemic antifungal treatment to achieve complete resolution. CONCLUSIONS: Onychomycosis should be included in the group of pathologies that improve with cART-induced immune reconstitution. The pathogenesis of onychomycosis in HIV disease warrants investigation in the context of cell-mediated immunity restoration.
Asunto(s)
Antirretrovirales/uso terapéutico , Antifúngicos/uso terapéutico , Terapia Antirretroviral Altamente Activa/métodos , Infecciones por VIH/tratamiento farmacológico , Onicomicosis/tratamiento farmacológico , Adulto , Linfocitos T CD4-Positivos/inmunología , Quimioterapia Combinada , Dermatosis del Pie/complicaciones , Dermatosis del Pie/tratamiento farmacológico , Dermatosis del Pie/inmunología , Infecciones por VIH/complicaciones , Infecciones por VIH/inmunología , Dermatosis de la Mano/complicaciones , Dermatosis de la Mano/tratamiento farmacológico , Dermatosis de la Mano/inmunología , Humanos , Inmunidad Celular/inmunología , Masculino , Persona de Mediana Edad , Onicomicosis/complicaciones , Onicomicosis/inmunología , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUNDS: One of the most frequent causes of allergic contact dermatitis of occupational origin are rubber additives, which are present in Personal Protective Equipment (PPE). The most allergenic additives of natural and synthetic gloves are thiurams, carbamates and mercapto group. OBJECTIVE: To investigate the state of knowledge about the chemical additives used in the manufacture of synthetic rubber gloves. METHODS: This was a qualitative research study in which professionals working in the manufacture, research, prescription and commercialization of gloves answered an open questionnaire. RESULTS: 30 individuals were interviewed: 4 researchers in occupational medicine, 5 occupational physicians, 2 occupational safety technicians, a rubber workers' union physician, an occupational safety engineer, a pro duction engineer of rubber gloves, 4 importers of gloves, a manufacturer of gloves, 3 businessmen who sell PPE, 3 salesclerks working in stores that sell PPE, 2 businessmen who own stores that sell products for allergic individuals, and 3 dermatologists. CONCLUSION: Knowledge of the chemical composition of rubber gloves is scant. The labeling of gloves, with the description of their chemical composition, would facilitate choosing the best type of glove for each person. This low-cost action to businesses would be a gain from the standpoint of public health, with huge repercussions for users of rubber gloves.
Asunto(s)
Dermatitis Alérgica por Contacto/etiología , Dermatitis Profesional/etiología , Guantes Protectores/efectos adversos , Dermatosis de la Mano/inducido químicamente , Dermatitis Alérgica por Contacto/inmunología , Dermatitis Alérgica por Contacto/prevención & control , Dermatitis Profesional/inmunología , Dermatitis Profesional/prevención & control , Dermatosis de la Mano/inmunología , Dermatosis de la Mano/prevención & control , Humanos , Pruebas del Parche , Goma/química , Encuestas y CuestionariosRESUMEN
FUNDAMENTOS: Uma das causas mais frequentes de dermatite de contato alérgica, de origem ocupacional, são os aditivos da borracha, presentes nos Equipamentos de Proteção Individual. Os aditivos das luvas natural e sintética mais alergênicos são tiurams, mercaptos e carbamatos. OBJETIVO: levantar o nível de conhecimento em relação aos aditivos químicos utilizados na fabricação das luvas de borracha sintética. MÉTODOS: Foi aplicado um questionário aberto a profissionais que trabalham com fabricação, pesquisa, prescrição e comercialização das luvas. Foi adotado o método de pesquisa qualitativa. RESULTADOS: Foram entrevistadas 30 pessoas: 4 pesquisadores na área de Medicina do Trabalho, 5 médicos do Trabalho, 2 técnicos de segurança do Trabalho, 1 médico do sindicato de trabalhadores da borracha, 1 engenheiro de Segurança do Trabalho, 1 engenheira de Produção do setor de fabricação de luvas de borracha, 4 empresários importadores de luvas, 1 empresário fabricante de luvas, 3 empresários que comercializavam Equipamentos de Proteção Individual, 3 vendedores de lojas de Equipamentos de Proteção Individual, 2 empresários de lojas que comercializavam produtos para alérgicos e 3 dermatologistas. CONCLUSÃO: O conhecimento da composição química das luvas é pequeno. A rotulagem das luvas, com a descrição da composição química, facilitaria a escolha do melhor tipo de luva para cada pessoa. Esta ação, de baixo custo para as empresas, seria um ganho, do ponto de vista da saúde pública, e teria grande repercussão nos usuários de luvas de borracha.
BACKGROUNDS: One of the most frequent causes of allergic contact dermatitis of occupational origin are rubber additives, which are present in Personal Protective Equipment (PPE). The most allergenic additives of natural and synthetic gloves are thiurams, carbamates and mercapto group. OBJECTIVE: To investigate the state of knowledge about the chemical additives used in the manufacture of synthetic rubber gloves. METHODS: This was a qualitative research study in which professionals working in the manufacture, research, prescription and commercialization of gloves answered an open questionnaire. RESULTS: 30 individuals were interviewed: 4 researchers in occupational medicine, 5 occupational physicians, 2 occupational safety technicians, a rubber workers' union physician, an occupational safety engineer, a pro duction engineer of rubber gloves, 4 importers of gloves, a manufacturer of gloves, 3 businessmen who sell PPE, 3 salesclerks working in stores that sell PPE, 2 businessmen who own stores that sell products for allergic indivi duals, and 3 dermatologists. CONCLUSION: Knowledge of the chemical composition of rubber gloves is scant. The labeling of gloves, with the description of their chemical composition, would facilitate choosing the best type of glove for each person. This low-cost action to businesses would be a gain from the standpoint of public health, with huge repercussions for users of rubber gloves.
Asunto(s)
Humanos , Dermatitis Alérgica por Contacto/etiología , Dermatitis Profesional/etiología , Guantes Protectores/efectos adversos , Dermatosis de la Mano/inducido químicamente , Dermatitis Alérgica por Contacto/inmunología , Dermatitis Alérgica por Contacto/prevención & control , Dermatitis Profesional/inmunología , Dermatitis Profesional/prevención & control , Dermatosis de la Mano/inmunología , Dermatosis de la Mano/prevención & control , Pruebas del Parche , Goma/química , Encuestas y CuestionariosAsunto(s)
Lepra Tuberculoide/diagnóstico , Complicaciones Infecciosas del Embarazo/microbiología , Brasil/etnología , Dapsona/uso terapéutico , Diagnóstico Tardío , Dermatosis Facial/diagnóstico , Dermatosis Facial/tratamiento farmacológico , Dermatosis Facial/inmunología , Dermatosis Facial/microbiología , Femenino , Dermatosis del Pie/diagnóstico , Dermatosis del Pie/tratamiento farmacológico , Dermatosis del Pie/inmunología , Dermatosis del Pie/microbiología , Dermatosis de la Mano/diagnóstico , Dermatosis de la Mano/tratamiento farmacológico , Dermatosis de la Mano/inmunología , Dermatosis de la Mano/microbiología , Humanos , Hipoestesia/etiología , Inmunidad Celular , Lepra Tuberculoide/tratamiento farmacológico , Lepra Tuberculoide/inmunología , Lepra Tuberculoide/microbiología , Exposición Profesional , Prednisona/uso terapéutico , Embarazo , Complicaciones Infecciosas del Embarazo/inmunología , Rifampin/uso terapéutico , EspañaRESUMEN
We previously described a new variant of endemic pemphigus foliaceus in El Bagre, Colombia, South America (El Bagre-EPF). On physical examination, the palms and soles of El Bagre-EPF patients reveal an edematous texture and mild hyperkeratosis, in comparison with the non-glabrous skin of the patients where blisters, pustules or other lesions are commonly found. Based on the preceding observation, we tested the palms of 20 El Bagre-EPF cases and 20 controls from the endemic area for any pathological alterations in the samples by direct immunofluorescence (DIF). Our DIF demonstrated pathological deposits of fibrinogen and albumin, as well as IgG, IgA, IgM, IgD and C3c, at 1) the epidermal basement membrane zone; 2) around isolated areas in the epidermis, 3) within the dermal vessels and nerves, and 4) in areas surrounding dermal neurovascular structures and sweat glands. Specific markers for blood vessels, including 1) anti-intercellular adhesion molecule 1 (ICAM-1)/CD54, and 2) anti-junctional adhesion molecule (JAM-A); as well as specific markers for nerves, including 1) anti-glial fibrillary acidic protein (GFAP), and 2) anti-human neuron specific enolase (NSE) co-localized with the patients' autoantibodies. Although no blisters, ulcerations, pustules or erosions are clinically observed on the palms of El Bagre-EPF patients, our DIF detected distinct immunoreactivity in palm tissue. These alterations may contribute to the clinically edematous texture of the palms and the mild clinical hyperkeratosis found in most of these patients. We propose that normal glabrous skin and non-glabrous skin may be different with regard to the expression of selected molecules, which may vary in number, size or structural organization depending on their anatomical site. Our findings may also partially explain the hyperkeratotic palms that have been clinically well documented in the chronic phase of fogo selvagem i.e., endemic pemphigus foliaceus, in Brazil.
Asunto(s)
Autoanticuerpos/análisis , Enfermedades Endémicas , Dermatosis de la Mano/inmunología , Pénfigo/inmunología , Piel/inmunología , Albúminas/análisis , Colombia/epidemiología , Fibrinógeno/análisis , Técnica del Anticuerpo Fluorescente Directa , Mano , Dermatosis de la Mano/metabolismo , Dermatosis de la Mano/patología , Humanos , Inmunoglobulinas/análisis , Pénfigo/epidemiología , Pénfigo/metabolismo , Pénfigo/patología , Piel/metabolismoRESUMEN
A case of subcutaneous phaeohyphomycosis caused by Cladophialophora sp. is reported. The patient, an immunosuppressed host presented a nodule on the dorsum of the right hand which relapsed four months after excision. Dematiaceous septate hyphal and yeast like elements were seen in mycological and histological examination. The isolated fungus was identified on the basis of micro-macromorphological and physiologic characteristics.
Asunto(s)
Ascomicetos/aislamiento & purificación , Dermatomicosis/microbiología , Dermatosis de la Mano/microbiología , Huésped Inmunocomprometido , Dermatomicosis/inmunología , Dermatomicosis/cirugía , Femenino , Dermatosis de la Mano/inmunología , Dermatosis de la Mano/cirugía , Humanos , Persona de Mediana Edad , RecurrenciaRESUMEN
A case of subcutaneous phaeohyphomycosis caused by Cladophialophora sp. is reported. The patient, an immunosuppressed host presented a nodule on the dorsum of the right hand which relapsed four months after excision. Dematiaceous septate hyphal and yeast like elements were seen in mycological and histological examination. The isolated fungus was identified on the basis of micro-macromorphological and physiologic characteristics.
É descrito caso de feohifomicose subcutânea causada por Cladophialophora sp. O paciente, imunossuprimido, apresentou nódulo no dorso da mão direita que recidivou quatro meses após excisão. Os exames micológico e histopatológico evidenciaram hifas septadas demácias e células leveduriformes. O fungo foi identificado com base no estudo micro-macromorfológico e fisiológico.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Ascomicetos/aislamiento & purificación , Dermatomicosis/microbiología , Dermatosis de la Mano/microbiología , Huésped Inmunocomprometido , Dermatomicosis/inmunología , Dermatomicosis/cirugía , Dermatosis de la Mano/inmunología , Dermatosis de la Mano/cirugía , RecurrenciaRESUMEN
We present a case of papular-purpuric "gloves and socks" syndrome (PPGSS) in an adult male with acute parvovirus B19 infection. The patient displayed the classical features of fever, oral lesions, and purpura on hands and feet, but the purpuric lesions on the feet evolved to superficial skin necrosis, a feature not previously described in this syndrome. We believe this is the first reported case of PPGSS occurring in Brazil