RESUMO

OBJECTIVES: The aim was to describe pregnancy outcomes after Zika virus (ZIKV) infection in a non-endemic region. METHODS: According to the Spanish protocol issued after the ZIKV outbreak in Brazil in 2015, all pregnant women who had travelled to high-burden countries were screened for ZIKV. Serological and molecular tests were used to identify ZIKV-infected pregnant women. They were classified as confirmed ZIKV infection when reverse transcription (RT) PCR tested positive, or probable ZIKV infection when ZIKV immunoglobulin M and/or immunoglobulin G and ZIKV plaque reduction neutralization tests were positive. Women found positive using molecular or serological tests were prospectively followed-up with ultrasound scans and neurosonograms on a monthly basis until delivery; magnetic resonance imaging and amniotic fluid testing were performed after signed informed consent. Samples of placenta, and fetal and neonatal tissues were obtained. RESULTS: Seventy-two pregnant women tested positive for ZIKV infection: ten were confirmed by RT-PCR, and 62 were probable cases based on serological tests. The prevalence of adverse perinatal outcomes was 33.3% (three out of nine, 95% CI 12.1-64.6%): two cases of congenital ZIKV syndrome (CZS) and one miscarriage, all born to women infected in the first trimester of gestation. All ZIKV-confirmed women had persistent viraemias beyond 2 weeks (median 61.50 days; IQR 35.50-80.75). Amniotic fluid testing was only positive in the two fetuses with anomalies. CONCLUSION: The prevalence of perinatal adverse outcomes for women with ZIKV-confirmed infection was 33.3%. Amniocentesis for ZIKV RT-PCR is recommended when fetal abnormalities are found. Intensive prenatal and postnatal follow-up of ZIKV-infected pregnancies is advised in confirmed cases.

Assuntos

RESUMO

El objetivo del Consenso Mexicano para el Tratamiento de la Hepatitis C fue el de desarrollar un documento como guía en la práctica clínica con aplicabilidad en México. Se tomó en cuenta la opinión de expertos en el tema con especialidad en: gastroenterología, infectología y hepatología. Se realizó una revisión de la bibliografía en MEDLINE, EMBASE y CENTRAL mediante palabras claves referentes al tratamiento de la hepatitis C. Posteriormente se evaluó la calidad de la evidencia mediante el sistema GRADE y se redactaron enunciados, los cuales fueron sometidos a voto mediante un sistema modificado Delphi, y posteriormente se realizó revisión y corrección de los enunciados por un panel de 34 votantes. Finalmente se clasificó el nivel de acuerdo para cada oración. Esta guía busca dar recomendaciones con énfasis en los nuevos antivirales de acción directa y de esta manera facilitar su uso en la práctica clínica. Cada caso debe ser individualizado según sus comorbilidades y el manejo de estos pacientes siempre debe ser multidisciplinario.

The aim of the Mexican Consensus on the Treatment of Hepatitis C was to develop clinical practice guidelines applicable to Mexico. The expert opinion of specialists in the following areas was taken into account: gastroenterology, infectious diseases, and hepatology. A search of the medical literature was carried out on the MEDLINE, EMBASE, and CENTRAL databases through keywords related to hepatitis C treatment. The quality of evidence was subsequently evaluated using the GRADE system and the consensus statements were formulated. The statements were then voted upon, using the modified Delphi system, and reviewed and corrected by a panel of 34 voting participants. Finally, the level of agreement was classified for each statement. The present guidelines provide recommendations with an emphasis on the new direct-acting antivirals, to facilitate their use in clinical practice. Each case must be individualized according to the comorbidities involved and patient management must always be multidisciplinary.

Assuntos

RESUMO

The aim of the Mexican Consensus on the Treatment of HepatitisC was to develop clinical practice guidelines applicable to Mexico. The expert opinion of specialists in the following areas was taken into account: gastroenterology, infectious diseases, and hepatology. A search of the medical literature was carried out on the MEDLINE, EMBASE, and CENTRAL databases through keywords related to hepatitisC treatment. The quality of evidence was subsequently evaluated using the GRADE system and the consensus statements were formulated. The statements were then voted upon, using the modified Delphi system, and reviewed and corrected by a panel of 34 voting participants. Finally, the level of agreement was classified for each statement. The present guidelines provide recommendations with an emphasis on the new direct-acting antivirals, to facilitate their use in clinical practice. Each case must be individualized according to the comorbidities involved and patient management must always be multidisciplinary.

Assuntos

RESUMO

Thin-layer diffusion conditions were accomplished on screen-printed electrodes by placing a controlled-weight onto the cast solution and allowing for its natural spreading. The restricted diffusive conditions were assessed by cyclic voltammetry at low voltage scan rates and electrochemical impedance spectroscopy. The relationship between the weight exerted over the drop and the thin-layer thickness achieved was determined, in such a way that the simple experimental set-up designed for this work could be developed into a commercial device with variable control of the thin-layer conditions. The experimental results obtained resemble those reported for the voltammetric features of electroactive soluble species employing electrodes modified with carbon nanotubes or graphene layers, suggesting that the attainment of the benefits reported for these nanomaterials could be done simply by forcing the solution to spread over the screen-printed electrodic system to form a thin layer solution. The advantages of thin-layer voltammetry in the kinetic characterization of quasi-reversible and irreversible processes are highlighted.

RESUMO

OBJETIVOS: demostrar la utilidad del método serológico directo para detección de hipotiroidismo congénito. MÉTODOS: es un estudio transversal, comparativo; destinado a comparar la capacidad diagnóstica de la técnica del papel filtro con la detección serológica directa de TSH neonatal en el mismo grupo de neonatos examinados. Se incluyó a 202 Recién Nacidos sanos del Hospital Materno Infantil Cochabamba, entre las 48 hrs. y los 21 días de vida; en el primer trimestre del año 2014. El análisis estadístico se realizó comparando las curvas de sensibilidad y especificidad con el Receiver Operating Characteristic (Característica Operativa del Receptor), del paquete estadístico especializado MedCalc, versión 12.7. El análisis descriptivo se realizó con el paquete estadístico SPSS-IBM STADISTIC, versión 19. RESULTADOS: ambas técnicas mostraron sensibilidad y especificidad altas, con un área bajo la curva de ambas, cercana a 0.972 (ROC), IC 0,941 - 0,989, al 95%. CONCLUSIONES: ambas técnicas demostraron ser eficientes en la pesquisa diagnóstica de hipotiroidismo congénito.

Objectives: to demonstrate the usefulness of direct serological method for direct detection of congenital hypothyroidism. Methods: a cross-sectional comparative study; for comparing the diagnostic performance of the technique of filter paper with the direct serological detection of neonatal TSH in the same group of infants examined. The study included 202 healthy newborns Hospital Materno Infantil Cochabamba, between 48 hrs. and 21 days of life; in the first quarter of 2014. The statistical analysis was performed comparing the curves of sensitivity and specificity with the Receiver Operating Characteristic (Receiver Operating Characteristic), specialized MedCalc statistical package, version 12.7. The descriptive analysis was performed using SPSS-IBM STADISTIC, version 19. Results: both techniques showed high sensitivity and specificity, with an area under the curve both close to 0.972 (ROC) IC 0.941 to 0.989, 95 %. Conclusions: both techniques proved effective in the diagnostic screening for congenital hypothyroidism.

Assuntos

RESUMO

One hundred forty-three penicillinase-producing Neisseria gonorrhoeae (PPNG) isolates obtained in Argentina from 2008 and 2012 were examined to detect blaTEM-135 genes and to investigate plasmid profiles and multiantigen sequence types. Forty-two PPNG isolates were found to carry TEM-135, and two contained a new TEM derivative characterized as TEM-220. The blaTEM-135 allele was carried by the Toronto/Rio and African plasmids. Molecular epidemiology revealed that two blaTEM-135 isolates were related to previously described isolates from Thailand and China, indicating a common evolutionary origin.

Assuntos

RESUMO

UNLABELLED: Sensitization to HLA antigens creates an obstacle for the accessibility and success of kidney transplantation (KT). Highly sensitized patients have longer waiting times and some may never receive a KT. AIM: To determine the probability of patients on the deceased donor (DD) waiting list to receive a KT based on the panel reactive antibody percentage (% PRA) in our center. METHODS: The DD waiting list from our institution was analyzed from 01/05 to 08/12 documenting the clinical variables from donor and potential recipients (ABO blood group), lymphocyte cross-match [CxM (CDC-AHG)] results, highest % PRA determination, and time on the waiting list. The patients were classified into 4 groups based on the % PRA: 0%, 1-19%, 20-79% and 80-100%. The data was analyzed using odds ratio and logistic regression (significant p<0.05). RESULTS: 58 DD (F:M 34:24, ABO group O=35, A=13, B=10) and 179 potential recipients were analyzed (F:M 98:81, ABO group O=127, A=33, B=19, participating 4.2 ± 3.8 times with different donors to receive KT). The mean PRA for the whole group was 22 ± 32%, median [md] 0 (0-98). A total of 100 patients received KT (mean waiting time 2.2 ± 1.7 years, 12 days-7 years) and their mean % PRA was 11.6 ± 24, md 0 (0-94) vs. 31.4 ± 37 md 8.5 (0-98) in those who have not received a KT. An association between the % PRA group and KT (p<0.003) was observed. The probability of receiving KT with a 0% PRA vs. >0% was higher (OR 2.12, 1.17-3.84). There was no difference between the 0% vs. 1-19% group (OR 1); differences were observed between 0% vs. 20-79% (OR 2.5, 1.18-5.3) and 0% vs. 80-100% (OR 5, 1.67-14.9). For every percent increase in the PRA above 20%, the risk of not receiving a KT increased by 5% (1-9, p<0.01). CONCLUSIONS: The probability of receiving a DD kidney transplant is inversely related to the % PRA although a higher risk for not receiving a KT becomes evident with a PRA >20%.

Assuntos

RESUMO

En una revisión de archivo relacionado a lesiones intestinalespor traumatismo cerrado de abdomen, durante un periodo de4 años, desde enero del año 2007 a diciembre del 2010 y, quefueron tratados quirúrgicamente en el servicio de EmergenciasMédicas de Asunción Paraguay MSP Y BS, se evidenció:a) Su relación importante a accidentes de vehículos automotores.b) La presencia de graves lesiones asociadas a su presentación.c) La mayor frecuencia observada en personas jóvenes ydel sexo masculino.d) La alta frecuencia de lesiones del intestino delgado enrelación a las de colon.

Assuntos

RESUMO

Seagrasses are highly productive coastal ecosystems with a high diversity and abundance of fishes, very important to support artisanal fisheries. We analyzed the fish community structure of Thalassia testudinum in the communities of Manzanillo (M) and La Brea (LB), Northwest coast of Cariaco Gulf, Venezuela. Samples were taken monthly (Nov. 2006-Oct. 2007) from each place, using a beach net. A total of 34 810 fishes were captured, grouped into 13 orders, 36 families and 83 species. In both areas (M and LB), the number of species was similar, but a variation in their abundance was found: a total of 55 species and 13 210 organisms for M, and 58 species and 21 600 organisms for LB. The most abundant species and those with the highest biomasses in both areas were: Nicholsina usta, Haemulon boschmae, H. steindachneri, Harengula jaguana, Halichoeres bivittatus and Hemiramphus brasiliensis. The occasional visitors were the most frequent community components with a 59%, the cyclical and permanent residents were represented by the 22% and 19%, respectively. The H'n average for M was of 1.71+/-0.64bits/ind., while for LB was of 1.95+/-0.51bits/ind. The diversity values were directly related to the evenness and inversely related to the dominance. The low values of similarity indexes among localities allow us to assert that these fish communities are dissimilar, because of the structure of each Thalassia meadow and their connectivity with other systems.

Assuntos

RESUMO

El hemangioma cavernoso orbitario (HCO) constituye una tumoración vascular benigna no infiltrante, que crece lentamente y en función de la clínica, se decidirá la actitud terapéutica más conveniente, la observación o la extirpación quirúrgica. El diagnóstico definitivo se establece tras la extirpación del tumor y posterior estudio histopatológico del mismo. Presentamos el caso de una niña de 6 años de edad, con proptosis ocular derecha progresiva, con diagnóstico imagenológico sugestivo de lesión vascular, el cual fue confirmado en el estudio anatomo-patológico tras la intervención quirúrgica y la paciente evolucionó satisfactoriamente.

Assuntos

RESUMO

Fluoroquinolone resistance is a growing problem that has only recently emerged in S. agalactiae. Between 2005-2007, WHONET--Argentina network evaluated levofloxacin susceptibility in 1128 clinical S. agalactiae isolates, 10 (0.9%) of which proved to be resistant. Nine of them had come from 5 hospitals (in Buenos Aires City and 4 Argentinean provinces) and recovered from urine (n=7) and vaginal screening cultures (n=2). Three strains were also resistant to macrolides, lincosamides and B streptogramins due to the ermA gene. All nine fluoroquinolone-resistant isolates bore the same two mutations, Ser79Phe in ParC and Ser81Leu in GyrA proteins. Genetic relationships were analyzed by Apal-PFGE and two clones were determined, A (n=6) and B (n=3). To our knowledge, these are the first fluoroquinolone-resistant S. agalactiae isolates detected in Latin America.

Assuntos

Assuntos

Assuntos

RESUMO

This study evaluates the association of Triage (Tr), body temperature (t) and Oxygen saturation (SatO2) at the time of admission to a Pediatric Emergency Service (PES) with discharge home or hospitalization. Method: 1 863 patients admitted to a PES in June and July of 2007 were included, stratified by age (< 2 mo, 3-12 mo, 13-36 m, 37-60 mo, 61-120 mo, 121-187 mo). Chi Square test was used, screening for p < 0.05. Results: Hospitalization was most likely for children under 6 months old, (5.42, range 3.9-7.6), scoring Triage < 2 (6.9, range 4.7-10.2), or a Saturation level below 93 percent (23.68, range 14.6-38.3). No significant association was seen between fever and hospitalization (1.31, range 0.9-1.8). SatO2 < 93 percent was associated to tachycardia in all ages (3.62, range 2.09-5.79), so did fever (6.74, range 5.07-8.67). Over half (51.8 percent) of children with fever showed tachycardia, 22.8 percent of afebrile cases were associated to this symptom. Discussion: Risk of hospitalization is higher if a child is younger than 6 months old, with Oxygen Saturation below 93 percent or Triage level < 2. Over 600 children presented tachycardia (33 percent); none progressed to Shock even with SatO2 < 93 percent or Triage level < 2. Tachycardia, as an isolated sign, does not appear to be forecast significant hemodynamic change or need to be treated as such.

Se indagó la asociación Triage (Tr)- temperatura corporal (T°) y saturación de oxígeno (SO2) al consultar en Urgencia, con alta u hospitalización y se postuló asociaciones de taquicardia con T° y SO2. Pacientes y Método: Se configuró un grupo de 1 863 pacientes, de quienes acudieron en junio y julio 2007. Se emplearon razones de riesgo (OR) con IC95 por ciento y análisis estratificado por grupos de edad: < 2 m; 3-12 m; 13-36 m; 37-60 m; 61-120 m; 121-187 m. Se empleó X2 y p ≤ 0,05. Resultados: La probabilidad de hospitalización fue mayor al ser < de 6m (OR = 5,42; IC95 por ciento = 3,9-7,6), tener Triage ≤ 2 (OR: 6,94; IC95 por ciento: 4,7-10,2) o SO2 < a 93 por ciento (OR = 23,68; IC95 por ciento = 14,6-38,3). No se encontró asociación entre fiebre y hospitalización (OR = 1,31; IC95 por ciento = 0,9-1,8; NS) La SO2 < 93 por ciento, se asoció con taquicardia en todas las 3,62; IC95 por ciento = 2,09-5,79; p < 0,000), igual ocurre cuando hubo fiebre (OR = 5,07-8,67; p < 0,000). El 51,8 por ciento de los casos febriles estaban taquicárdicos y el edades (OR ponderado = ponderado = 6,74; IC95 por ciento 22,8 por ciento de los afebriles. Comentario: El riesgo de hospitalización en un niño es mayor si tiene < 6 m, ≤ SO(2)93 por ciento o Triage ≤ 2. En más de 600 niños taquicárdicos (33 por ciento) ninguno evolucionó al shock, incluso si tuvieron Triage ≤ 2 y SO2 ≤ 93. La taquicardia como signo relativamente aislado, no permite plantear alteración hemodinámica de magnitud y menos tratarla como si fuere.

Assuntos

RESUMO

In this work we have characterized the virus (RSV(48)) present in passage 48 of a respiratory syncytial virus persistently infected murine macrophage-like cell culture. This virus was noncytopathic in macrophages and had a low-fusogenic activity in RSV-permissive cell lines, although the level of this activity varied among the different cell lines tested. The fusogenic activity of RSV(48) in Vero cells, as evaluated by the number and size (nuclei per syncytium) of syncytia, was lower than that shown in cells H358. However, the syncytia formed by RSV(48) in Vero cells increased significantly when the virus was treated with trypsin previous to cell infection and the protease was left in the medium during the development of polykarions. Moreover, the fusogenic activity of RSV(48) was increased by a brief acidic pH treatment of infected cells. These results imply that the RSV(48) F protein was inefficiently activated by intracellular proteases in Vero cells and exposure to low pH favours membrane fusion. Analysis of the nucleotide and the deduced amino acid sequences of the RSV(48) F protein showed nine amino acid residue differences with respect to the RSV(wt) sequence, some of which mapped to positions that suggest they might be responsible for the low-fusogenic activity observed for the RSV(48) F protein.

Assuntos

RESUMO

Resistance phenotypes characterized by minimum inhibitory concentration, disk diffusion and beta-lactamase production were determined in 434 isolates from patients attending the Sexually Transmitted Disease Service at Dr. José Maria Cullen Hospital in Santa Fe, Argentina. Susceptibility tests to penicillin, tetracycline, ciprofloxacin, espectinomycin, azithromycin and ceftriaxone were performed. Pulsed-field gel electrophoresis was conducted made to on three ciprofloxacin-resistant isolates. Epidemiologically speaking, three interesting events should be highlighted: during 1997, plasmid-mediated high level tetracycline-resistant strains were observed (33.3%); from 2002 to 2004 a significant increase of plasmid-mediated penicillin-resistant strains was registered (9.7% to 34.8%); and in the year 2000 the first two quinolone-resistant strains emerged in the province. In our hospital, the first azithromycin-resistant isolate emerged in 2004. We therefore emphasize the importance of the Clinical Microbiology Laboratory in order to provide information for the empiric treatment of this infection.

Assuntos

RESUMO

A case of Streptococcus suis meningitis is described in an immunocompetent patient presenting asthenia, general weakness, fever, vomiting, sensory deterioration and temporospatial disorder. The cerebrospinal fluid and two blood cultures (2/2 bottles) were positive. The isolate was preliminary identified by conventional biochemical tests, and the identification was completed at the Special Bacteriology Service of INEI-ANLIS "Dr. Carlos G. Malbrán". Ampicillin and ceftriaxone treatment was initiated. The isolate was susceptible to ampicillin, cefotaxime and vancomycin. The patient experienced a good outcome but suffered hearing loss. However, after four months he returned with walking ataxia, deafness in his left ear, and hearing loss in the right ear. The patient's retrospective exposure to pigs had been verified. It is important to evaluate predisposing and epidemiologic factors in order to alert about the possible presence of this etiological agent in cases of meningitis or bacteremia.

Assuntos

RESUMO

Se describe un caso de meningitis por Streptococcus suis en un paciente inmunocompetente. Presentaba astenia, debilidad generalizada, fiebre (39 °C), vómitos, deterioro del sensorio y desorientación témporo-espacial. Los cultivos de sangre (2/2) y de líquido cefalorraquídeo fueron positivos. La identificación preliminar se realizó utilizando las pruebas bioquímicas convencionales y fue completada en el Servicio Bacteriología Especial del INEI-ANLIS "Dr. Carlos G. Malbrán". Se comenzó el tratamiento con ampicilina y ceftriaxona. El microorganismo aislado demostró sensibilidad a ampicilina, cefotaxima y vancomicina. El paciente evolucionó favorablemente, pero se comprobó leve hipoacusia. Reingresó a los 4 meses con marcha atáxica, anacusia en oído izquierdo e hipoacusia en oído derecho. Continúa con seguimiento neurológico y audiométrico. Retrospectivamente se constató el contacto del paciente con cerdos. Se destaca la importancia de la anamnesis para alertar la sospecha de este agente etiológico en meningitis y bacteriemias.

A case of Streptococcus suis meningitis is described in an immunocompetent patient presenting asthenia, general weakness, fever, vomiting, sensory deterioration and temporospatial disorder. The cerebrospinal fluid and two blood cultures (2/2 bottles) were positive. The isolate was preliminary identified by conventional biochemical tests, and the identification was completed at the Special Bacteriology Service of INEI-ANLIS "Dr. Carlos G. Malbrán". Ampicillin and ceftriaxone treatment was initiated. The isolate was susceptible to ampicillin, cefotaxime and vancomycin. The patient experienced a good outcome but suffered hearing loss. However, after four months he returned with walking ataxia, deafness in his left ear, and hearing loss in the right ear. The patient’s retrospective exposure to pigs had been verified. It is important to evaluate predisposing and epidemiologic factors in order to alert about the possible presence of this etiological agent in cases of meningitis or bacteremia.

Assuntos

RESUMO

Se determinaron los fenotipos de resistencia caracterizados por la concentración inhibitoria mínima, la difusión con discos y la producción de β-lactamasa de 434 aislamientos de Neisseria gonorrhoeae obtenidos de pacientes atendidos en el Servicio de Enfermedades de Transmisión Sexual del Hospital Dr. José María Cullen, Santa Fe, Argentina. Se realizaron pruebas de sensibilidad a los siguientes antimicrobianos: penicilina, tetraciclina, ciprofloxacina, espectinomicina, azitromicina y ceftriaxona. A tres aislamientos resistentes a ciprofloxacina se les realizó electroforesis de campo pulsado. Se destacaron tres situaciones epidemiológicas de interés: en el año 1997, alta incidencia de aislamientos con resistencia plasmídica a tetraciclina (33,3%); en el período 2002-2004, un aumento significativo de la resistencia plasmídica a penicilina (9,7% a 34,8%); y en el año 2000, la emergencia de dos de los tres primeros aislamientos con resistencia a quinolonas del país. El primer aislamiento resistente a azitromicina en nuestro hospital emerge en el 2004. Este trabajo jerarquiza el rol del Laboratorio de Microbiología Clínica en la orientación del tratamiento empírico de la gonorrea.

Resistance phenotypes characterized by minimum inhibitory concentration, disk diffusion and β-lactamase production were determined in 434 isolates from patients attending the Sexually Transmitted Disease Service at Dr. José María Cullen Hospital in Santa Fe, Argentina. Susceptibility tests to penicillin, tetracycline, ciprofloxacin, espectinomycin, azithromycin and ceftriaxone were performed. Pulsed-field gel electrophoresis was conducted made to on three ciprofloxacin-resistant isolates. Epidemiologically speaking, three interesting events should be highlighted: during 1997, plasmid-mediated high level tetracycline-resistant strains were observed (33.3%); from 2002 to 2004 a significant increase of plasmid-mediated penicillin-resistant strains was registered (9.7% to 34.8%); and in the year 2000 the first two quinolone-resistant strains emerged in the province. In our hospital, the first azithromycin-resistant isolate emerged in 2004. We therefore emphasize the importance of the Clinical Microbiology Laboratory in order to provide information for the empiric treatment of this infection.

Assuntos

RESUMO

Se presenta el caso de un paciente alcoholista con una ulceración perianal y manifestaciones cutáneas de enfermedad de Hansen. La biopsia de la lesión perianal y otros estudios arribaron al diagnóstico de una forma diseminada de paracoccidioidomicosis, así como también las biopsias cutáneas y los estudios baciloscópicos fueron diagnósticos de lepra lepromatosa. La respuesta a la terapéutica fue satisfactoria con desaparición de las lesiones cutáneas. La disminución de la respuesta inmunológica celular genera un terreno propicio para la infección de estos gérmenes y al compartir área endémica la asociación entre ambas patologías puede ocurrir.

Lepra and Paracoccidioidomycosis are endemic diseases in Argentina. We report a case of a patient with an unusual perianal ulceration and cutaneous manifestations of Hansen's disease. The biopsy of perianal lesion and subsequent studies revealed a disseminated form of paracoccidioidomycosis, as well as skin biopsy and baciloscopic finding diagnostic of Lepromatous Leprosy. The main portal of entry of paracoccidioides is the lung. Hematogenous dissemination of the fungus may occur at this time, with the establishment of metastatic foci in any organ. Anal and perianal lesions are present only in 1.3 to 2.4% of the patients. The pathogenesis of anal lesions remains unclear, it may be secondary from a systemic or a local disease. The patient response to the therapeutic was notable, with disappearance of lesions up to the third month of started itraconazole orally 400 mg/day leading just atrophy scars in perianal areas. The treatment of Hansen's disease was made according to OMS guidelines for multibacillary disease.

Assuntos