RESUMO
Tracking the history of the discovery of mycetoma is not simple because identifying the roots of medical knowledge depends on utilising sources that employ imprecise and sometimes confusing descriptions when compared with those based on modern medical terminology. Ancient sources of information include writings, such as poetry, archaeology and paleopathology, as well as legend and folklore. The earliest precise descriptions of mycetoma were recorded in the mid-19th century by medical officers working in southern India. But interest in the disease spread rapidly both among doctors in India and elsewhere, from Algeria to Mexico to Sudan. Although over time the names of organisms have changed, the clinical and pathological descriptions still stand as testament to those early detailed studies. Some of the conclusions of the early investigators, particularly the general lack of effective treatment and the difficulty in diagnosis, remain true today.
Assuntos
Micetoma , Médicos , História do Século XIX , História do Século XX , História Antiga , Humanos , Índia , México , Micetoma/diagnóstico , SudãoRESUMO
We report a case of eumycetoma due to Madurella mycetomatis affecting the left dorsal forefoot in a 35-year-old woman. She had spent her childhood in Jamaica, and had been resident in the U.K. for 20 years prior to her presentation. She gave a highly suggestive history for a mycetoma, having observed the intermittent discharge of black grains from the lesion. The diagnosis was confirmed by histological and mycological analysis of the grains, and a magnetic resonance imaging scan excluded osteomyelitis. She has responded very favourably to treatment with itraconazole. Mycetomas due to M. mycetomatis have not previously been reported from Jamaica.
Assuntos
Dermatoses do Pé/diagnóstico , Madurella , Micetoma/diagnóstico , Adulto , Feminino , Seguimentos , Dermatoses do Pé/microbiologia , Humanos , Jamaica , ViagemRESUMO
Histoplasmosis is an important systemic fungal infection, particularly among immunocompromised individuals, who may develop a progressive disseminated form which is often fatal if it is untreated. In such patients, the detection of antibody responses for both diagnosis and follow-up may be of limited use, whereas the detection of Histoplasma capsulatum var. capsulatum antigens may provide a more practical approach. We have recently described an inhibition enzyme-linked immunosorbent assay (ELISA) for the detection in patients' sera of a 69- to 70-kDa H. capsulatum var. capsulatum-specific antigen which appears to be useful in diagnosis. To investigate its potential for the follow-up of histoplasmosis patients during treatment, antigen titers in the sera of 16 patients presenting with different clinical forms of histoplasmosis were monitored at regular intervals for up to 80 weeks. Sera from four of five patients with the acute form of the disease showed rapid falls in antigenemia, becoming antigen negative by week 14 (range, weeks 10 to 16). Sera from four patients with disseminated histoplasmosis showed falls in antigen levels; three of them became antigen negative by week 32; the fourth patient became negative by week 48. In contrast, antigen titers in four of six AIDS patients with the disseminated form of the disease remained positive throughout follow-up. Sera from only one patient who presented with the chronic form of the disease were analyzed, and this individual's serum became antigen negative by week 9. The inhibition ELISA is shown to be of particular use in the monitoring of non-AIDS patients with the acute and disseminated forms of the disease and may complement existing means of follow-up.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Antifúngicos/uso terapêutico , Antígenos de Fungos/sangue , Fungemia/diagnóstico , Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Itraconazol/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/sangue , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Adolescente , Adulto , Anfotericina B/uso terapêutico , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , Fungemia/sangue , Fungemia/tratamento farmacológico , Histoplasmose/sangue , Humanos , Lactente , Masculino , Sensibilidade e Especificidade , Fatores de TempoRESUMO
Serological diagnosis and follow-up of paracoccidioidomycosis (PCM) patients have relied mainly on the detection of antibody responses by using techniques such as complement fixation (CF) and immunodiffusion. We recently described a novel inhibition enzyme-linked immunosorbent assay (inh-ELISA) which proved to be useful in the diagnosis of PCM via the detection of an 87-kDa determinant in patient sera (B. L. Gomez, J. I. Figueroa, A. J. Hamilton, B. Ortiz, M. A. Robledo, R. J. Hay, and A. Restrepo, J. Clin. Microbiol. 35:3278-3283, 1997). This test has now been assessed as a means of following up PCM patients. A total of 24 PCM patients, classified according to their clinical presentation (6 with the acute form of the disease, of whom two had AIDS, 12 with the multifocal form of the disease, and 6 with the unifocal form of the disease), were studied. The four human immunodeficiency virus-negative patients with acute PCM showed a statistically significant decrease in circulating antigen levels after the start of antifungal therapy. Antigen levels in this group became negative by our criteria (
Assuntos
Antígenos de Fungos/sangue , Fungemia/diagnóstico , Paracoccidioides/imunologia , Paracoccidioidomicose/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Doença Aguda , Adolescente , Adulto , Idoso , Antifúngicos/uso terapêutico , Antígenos de Fungos/química , Ensaio de Imunoadsorção Enzimática/métodos , Epitopos/sangue , Epitopos/química , Feminino , Fungemia/tratamento farmacológico , Fungemia/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Peso Molecular , Paracoccidioides/isolamento & purificação , Paracoccidioidomicose/tratamento farmacológico , Paracoccidioidomicose/microbiologia , Fatores de TempoRESUMO
The precise diagnosis of paracoccidioidomycosis, in most cases, is established by direct methods and indirect immunological tests. The latter method is reliant on the identification of the host's humoral responses, which are usually impaired or absent in patients with severe juvenile forms of the disease and in immunocompromised patients. Determining disease activity or assessing treatment responses by measuring antibody levels is difficult, since antibody titer may remain elevated or persist at stationary levels, even in the presence of clinical improvement. Consequently, there is a need for alternative tests aimed at the identification of circulating antigens. A modification of the standard hybridoma production method was used to raise a panel of murine monoclonal antibodies (MAbs) against the yeast form of Paracoccidioides brasiliensis. Of these, MAb PIB, directed against an 87-kDa determinant, was used to develop an inhibition ELISA (inh-ELISA) capable of detecting as little as 5.8 ng of circulating antigen per ml of serum. Sera from 46 patients with paracoccidioidomycosis or other mycoses and sera from healthy individuals were evaluated by the inh-ELISA; overall sensitivity was 80.4% (37 of 46 paracoccidioidomycosis patients tested positive), and specificity compared with that of normal controls from areas of endemicity was 81.4%. The inh-ELISA detected circulating antigen in 100% of patients with the acute form of paracoccidioidomycosis and in 83.3 and 60% of patients with the chronic multifocal and unifocal forms of paracoccidioidomycosis according to the patients' clinical presentation. These results indicate that the inh-ELISA with MAb PIB is effective in the detection of circulating antigen and that this test may be useful for monitoring responses to treatment and establishing disease prognoses.
Assuntos
Anticorpos Antifúngicos , Anticorpos Monoclonais , Antígenos de Fungos/sangue , Paracoccidioides/imunologia , Paracoccidioidomicose/diagnóstico , Paracoccidioidomicose/microbiologia , Antígenos de Fungos/química , Ensaio de Imunoadsorção Enzimática/métodos , Ensaio de Imunoadsorção Enzimática/estatística & dados numéricos , Estudos de Avaliação como Assunto , Humanos , Peso Molecular , Micologia/métodos , Micologia/estatística & dados numéricos , Paracoccidioidomicose/imunologia , Sensibilidade e EspecificidadeRESUMO
Histoplasmosis is an important systemic fungal infection, particularly among immunocompromised individuals living or travelling in areas of endemicity, who, without antifungal therapy, may develop a progressive disseminated fatal infection. For such patients, the detection of antibody responses by immunodiffusion or complement fixation test is of limited use. In contrast, the detection of Histoplasma capsulatum circulating antigens may provide a more practical approach to the rapid diagnosis of the disease. Accordingly, an inhibition enzyme-linked immunosorbent assay (ELISA) for the detection of a 69- to 70-kDa H. capsulatum-specific determinant and incorporating a species-specific murine monoclonal antibody was developed. With sera from patients with different forms of the disease (n = 35), the overall sensitivity of the test was found to be 71.4%, while the specificity was found to be 98% with normal human sera from areas of endemicity (n = 44) and 85.4% with sera from patients with other chronic fungal or bacterial infections (n = 48). This novel, highly specific ELISA provides a significant addition to the existing diagnostic tests for the detection of histoplasmosis.
Assuntos
Antígenos de Fungos/isolamento & purificação , Ensaio de Imunoadsorção Enzimática/métodos , Histoplasmose/diagnóstico , Adolescente , Adulto , Anticorpos Antifúngicos , Anticorpos Monoclonais , Antígenos de Fungos/sangue , Antígenos de Fungos/urina , Criança , Feminino , Histoplasmose/sangue , Histoplasmose/urina , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
It has been suggested that black children of West Indian origin living in London have a higher prevalence of atopic dermatitis (AD) than their counterparts living in the Caribbean. (Williams HC et. al London-born black Caribbean children are at increased risk of atopic dermatitis. J Am Acad Dermatol 1995; 32: 212-7). To test this hypothesis, we undertook a colloborative study on the prevalence of atopic dermatitis in school children in Lambeth, London and Kingston, Jamaica. Questionnaires were sent to 2126 and 3957 parents of children aged 4 to 11 years attending seven primary schools in London and six schools in Kingston respectively. The questionnaires requested screening information on symptoms of AD and parentally nominated ethnic group of the child. Children whose parents responded affirmatively to the presence of an itchy rash or the presence of generally dry skin (N=562) were examined during two visits to the schools in London. In Kingston, all children whose parents responded and gave consent were examined (N=3027) by the same dermatologist. Cases of AD were defined using the UK Working Party's Diagnostic Criteria. The overall response rate in London and Kingston was 70.3 percent and 86.2 percent respectively. The overall prevalence of AD was 10.8 percent (162/1495) and 4.9 percent (166/3409) in London and Kingston respectively. The prevalence of AD in black children living in London was 18.9 percent (60/317) compared with 4.6 percent (94/2029). These results suggest that black Caribbean children in London are at an increased risk (odds ratio 4.81, 95 percent confidence interval 3.3 to 6.9, p<0.001) of developing atopic dermatitis when compared to their counterparts living in Jamaica. Possible reasons for these large prevalence differences are currently being investigated. (AU)
Assuntos
Criança , Humanos , Estudo Comparativo , Pré-Escolar , Dermatite Atópica/epidemiologia , Reino Unido , Jamaica , Negro ou Afro-Americano , Fatores de Risco , Prevalência , Estudos Transversais , Coleta de DadosRESUMO
A novel 58 kDa antigenic determinant of the fungus Paracoccidioides brasiliensis was identified by enzyme-linked immunosorbent assay using a panel of species-specific murine monoclonal antibodies (MAbs). Western immunoblot analysis, deglycosylation studies and isoelectric focusing indicated that this 58 kDa antigen is a glycoprotein, with a pI of approximately 5.2. The molecule was purified from P. brasiliensis culture filtrate and yeast cytoplasmic antigens by membrane ultrafiltration, liquid isoelectric focusing and gel filtration; N-terminal amino acid sequence data revealed no substantial homology with known proteins. The presence of the antigen in the cytoplasm of both yeast and mycelial forms of the fungus was demonstrated when these MAbs were used as markers in immunofluorescence, immunoperoxidase and immunoalkaline phosphatase techniques to label P. brasiliensis in cryostat sections. These MAbs also recognized the cytoplasm of P. brasiliensis yeast forms in paraffin-embedded pathological specimens from human cases. A preparation of the 58 kDa component from yeast cytoplasmic antigen was reacted by Western immunoblotting with 26 different serum samples from paracoccidioidomycosis patients, and 81% of them recognized it.
Assuntos
Antígenos de Fungos/análise , Epitopos/isolamento & purificação , Glicoproteínas/imunologia , Paracoccidioidomicose/imunologia , Adulto , Sequência de Aminoácidos , Anticorpos Monoclonais/imunologia , Western Blotting , Cromatografia em Gel , Ensaio de Imunoadsorção Enzimática , Humanos , Focalização Isoelétrica , Pessoa de Meia-Idade , Dados de Sequência Molecular , Peso Molecular , Paracoccidioides/imunologiaRESUMO
BACKGROUND: Previous reports suggest that atopic dermatitis is more common in black Caribbean children born in the United Kingdom than in white children. It is unclear whether these differences are caused by selection bias or variations in the use of the word "eczema" in the groups studied. OBJECTIVE: Our objective was to explore ethnic group differences in the prevalence of atopic dermatitis in London schoolchildren. METHODS: A cross-sectional prevalence survey of 693 junior school children in three schools was performed. Atopic dermatitis was defined in three ways: (1) by a dermatologist, (2) by visible flexural dermatitis as recorded by an independent observer, and (3) by a history of flexural dermatitis according to the child's parents. RESULTS: The prevalence of atopic dermatitis according to examination by a dermatologist was 16.3% in black Caribbean children and 8.7% in white children. This increased risk was present for different methods of defining of a atopic dermatitis and persisted after adjustment for potential confounders. CONCLUSION: London-born black Caribbean children appear to be at an increased risk of having atopic dermatitis.
Assuntos
População Negra , Dermatite Atópica/epidemiologia , Negro ou Afro-Americano/estatística & dados numéricos , Viés , Criança , Pré-Escolar , Fatores de Confusão Epidemiológicos , Estudos Transversais , Dermatite Atópica/diagnóstico , Eczema/diagnóstico , Eczema/epidemiologia , Etnicidade/estatística & dados numéricos , Humanos , Londres/epidemiologia , Prevalência , Rinite Alérgica Sazonal/epidemiologia , Fatores de Risco , Dermatopatias/epidemiologia , Classe Social , Índias Ocidentais/etnologia , População Branca/estatística & dados numéricosRESUMO
BACKGROUND: Previous reports suggest that atopic dermatitis is more common in black Caribbean children born in the United Kingdom than in white children. It is unclear whether these differences are caused by selection bias or variations in the use of the word "eczema" in the groups studied. OBJECTIVE: Our objective was to explore ethnic group differences in the prevalence of atopic dermatitis in London schoolchildren. METHOD: A cross-sectional prevalence survey of 693 junior school children in three schools was performed. Atopic dermatitis was defined in three ways: (1) by a dermatologist, (2) by visible flexural dermatitis as recorded by an independent observer, and (3) by a history of flexural dermatitis according to the child's parents. RESULTS: The prevalence of atopic dermatitis according to examination by a dermatologist was 16.3 percent in black Caribbean children and 8.7 percent in white children. This increased risk was present for different methods of defining of atopic dermatitis and persisted after adjustment for potential confounders. CONCLUSION: London-born black Caribbean children appear to be at an increased risk of having atopic dermatitis. (AU)
Assuntos
Humanos , Pré-Escolar , Criança , Dermatite Atópica/epidemiologia , Eczema/diagnóstico , Eczema/epidemiologiaRESUMO
PIP: In developing countries skin disease prevalences may affect over 60% of the community and are often poorly managed. The impact of ineffective treatment of skin disease on family life in rural Mexico was investigated. In the community of Cayaco, a house to house questionnaire survey was conducted to study the distribution of skin disease and the use and cost of treatments. The diagnosis of skin lesions was validated by physical examination and in a separate random survey in 120 primary school children. Regression analysis was carried out. 380 households with 1528 people (713 males, 815 women) were surveyed, of whom 207 reported skin disease. 131 attended the outpatient clinic (41 males, 90 females). The commonest skin disease among them was pyoderma (27 patients), followed by scabies (26), pityriasis alba (23), acne (8), dermatophytosis (8), viral warts (8), and pediculosis capitis (8). 66 had other skin conditions ranging from urticaria (2) to scrofuloderma (1). 58 patients had more than one condition, a total of 189 dermatoses. Six conditions accounted for 102 of the dermatoses. 15 patients with scabies and 21 with pyoderma had received ineffective treatment over the previous six months at a mean cost of 66 new pesos and 136 new pesos, respectively. Many of the affected children had missed school: eight days for scabies (12 patients) and 15 days for pyoderma (10 patients). 68 of the 120 primary school children in the random survey had at least one treatable skin condition. In half of the households people had symptoms, and 57% of the children had at least one treatable skin disease. The mean total cost of ineffective treatment for the two commonest conditions over six months was a major financial burden on families where the mean daily wage was 15.2 new pesos. Both diseases are readily curable by eliminating scabies. In the area a new system of community dermatology is implemented with close collaboration between specialists and primary health care workers.^ieng
Assuntos
Efeitos Psicossociais da Doença , Dermatopatias/economia , Absenteísmo , Feminino , Humanos , Masculino , México , Saúde da População Rural , Dermatopatias/terapia , Falha de TratamentoRESUMO
Four cases of human dermatophilosis observed in Rio de Janeiro, Brazil, are reported. Data that suggest nail infection by Dermatophilus congolensis are presented. The clinical spectrum of the disease ranged from an asymptomatic infection to a pustular eruption. Our findings suggest that epidermal Langerhans cells play a role in the pathogenesis of the infection.
Assuntos
Infecções por Actinomycetales/patologia , Queratinócitos/patologia , Células de Langerhans/patologia , Dermatopatias Bacterianas/patologia , Infecções por Actinomycetales/microbiologia , Adulto , Feminino , Humanos , Masculino , Microscopia Eletrônica , Pessoa de Meia-Idade , Dermatopatias Bacterianas/microbiologiaRESUMO
An extensive and severe actinomycetoma by Nocardia asteroides, a rare etiologic agent of this infection in Brazil, observed during a 9 year follow-up is reported. Unsuitable social and financial conditions led to amputation as the only possible solution for this case, no signs of infection relapse having been observed in three years after his surgery.
Assuntos
Dermatoses do Pé/patologia , Nocardiose/patologia , Nocardia asteroides , Adulto , Amputação Cirúrgica , Brasil , Seguimentos , Dermatoses do Pé/cirurgia , Humanos , Masculino , Nocardiose/cirurgia , Nocardia asteroides/isolamento & purificaçãoRESUMO
18 girls from an orphanage (Orfanato Santo Antônio) in Niterói presented tinea capitis due to Trichophyton tonsurans (15 cases-83.3%) and Microsporum canis (3 cases-26.7%). Comments are made about clinical, mycological and therapeutic aspects of this microepidemic.
Assuntos
Dermatomicoses/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Microsporum , Tinha do Couro Cabeludo/epidemiologia , Brasil/epidemiologia , Criança , Dermatomicoses/diagnóstico , Dermatomicoses/tratamento farmacológico , Feminino , Griseofulvina/administração & dosagem , Humanos , Microsporum/isolamento & purificação , Indução de Remissão , Tinha do Couro Cabeludo/diagnóstico , Tinha do Couro Cabeludo/tratamento farmacológico , Trichophyton/isolamento & purificaçãoRESUMO
A panel of four murine monoclonal antibodies showing species specificity for the yeast phase of the pathogenic dimorphic fungus Paracoccidioides brasiliensis was produced by using a modification of the standard monoclonal antibody technology. This involved the use of the immunosuppressive drug cyclophosphamide to suppress the immune response of test animals to fungi showing cross-reactivity, i.e., to Histoplasma capsulatum. One monoclonal antibody, P4, which had a high titer by enzyme-linked immunosorbent assay, was shown to recognize a linear antigenic epitope of P. brasiliensis at a molecular size of 70,000 to 75,000 daltons by Western blot (immunoblot) analysis. The potential use of these monoclonal antibodies, which are the first species-specific probes to P. brasiliensis that have been produced, in the field of serodiagnosis is discussed.
Assuntos
Anticorpos Monoclonais/imunologia , Fungos Mitospóricos/imunologia , Paracoccidioides/imunologia , Animais , Blastomyces/imunologia , Reações Cruzadas , Ensaio de Imunoadsorção Enzimática , Histoplasma/imunologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Especificidade da EspécieRESUMO
Onchocerciasis is a chronic parasitic infection in which infiltration of the skin by microfilariae has been associated with a number of different pathological changes. This survey compared the prevalence of different forms of skin disease in two villages, one of which was located within the endemic zone for onchocerciasis (Zapallo Grande), in a lowland rain forest area of western Ecuador. The commonest skin diseases in both villages were scabies, pyoderma and pityriasis versicolor. In addition changes closely correlated with the presence of microfilariae in skin snips were found in Zapallo Grande--such as atrophic gluteal changes, and acute and chronic papular dermatitis. The only other skin disease associated with onchocerciasis was widespread tinea corporis due to T. rubrum. The Amerindians in the endemic onchocerciasis area were more likely than Negroes to have generalized atrophic changes of the skin, whereas in the latter group significant numbers of individuals had no obvious skin lesions but large numbers of microfilariae were detected in skin snips. Acute papular dermatitis was common in both groups and in biopsied lesions microfilariae could usually be identified within the epidermis or close to the dermo-epidermal junction. One patient had developed severe reactive onchodermatitis (Sowda). Swabs taken from onchocercal skin lesions showed no evidence of skin surface carriage of Staphylococcus aureus. Changes classically associated with onchocerciasis such as pretibial hypopigmentation (leopard skin) and hanging groin were notably absent in this population.
Assuntos
Oncocercose/parasitologia , Dermatopatias Parasitárias/parasitologia , Pele/parasitologia , Adolescente , Adulto , Criança , Pré-Escolar , Equador , Humanos , Lactente , Pessoa de Meia-Idade , Dermatopatias/epidemiologia , Dermatopatias/etnologia , Dermatopatias Parasitárias/epidemiologia , Dermatopatias Parasitárias/etnologiaRESUMO
Thirty-one percent of a group of 49 hospitalized patients or laboratory workers in Guyana showed positive intradermal paracoccidioidin tests in the presence of negative histoplasmin reactions. In 2 patients (4%), the intradermal reactions to paracoccidioidin were greater than 10 mm in diameter. The prevalence of positive reactors in a selected population suggests that paracoccidioidomycosis may be endemic in Guyana although no clinical case has been reported from the country. A further survey in a larger, unselected population would lead to a clearer understanding of the problem.
Assuntos
Proteínas Fúngicas , Paracoccidioidomicose/imunologia , Adolescente , Adulto , Idoso , Criança , Coccidioidina/imunologia , Feminino , Guiana , Histoplasmina/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes CutâneosRESUMO
We report a case of chronic tongue ulceration caused by a systemic fungal infection rarely encountered in the United Kingdom--histoplasmosis.