RESUMO
Cutaneous Leishmaniasis due to Leishmania mexicana is a common cause of New World protozoal infections endemic to southern Mexico and now the United States (US). We present a case of a 72-year-old male who became infected with cutaneous L. mexicana while participating in numerous diving excursions in the flooded limestone caves, commonly referred to as cenotes, in the Yucatán Peninsula. This unique case of adventure tourism highlights cave diving in endemic regions of leishmaniasis as a possible new risk factor for the acquisition of this disease. We also discuss increasing autochthonous cases of cutaneous leishmaniasis and the different barriers to treatment that occur with this disease.
RESUMO
Reactivation of chronic Trypanosoma cruzi infection in solid organ transplant recipients (SOTRs) has been reported. The patient presented with a 2-week history of two painful erythematous, infiltrated plaques with central ulceration and necrotic crust on the left thigh. She had a history of chronic indeterminate Chagas disease (CD) and had received a kidney transplant before 2 months. Skin biopsies revealed lobular panniculitis with intracellular amastigote forms of T. cruzi. The patient was diagnosed with CD reactivation. Treatment with benznidazole significantly improved her condition. CD reactivation should be suspected in SOTRs living in endemic areas with clinical polymorphism of skin lesions.
Assuntos
Doença de Chagas , Transplante de Rim , Paniculite , Trypanosoma cruzi , Doença de Chagas/diagnóstico , Feminino , Humanos , Transplante de Rim/efeitos adversos , Coxa da PernaRESUMO
BACKGROUND: Polyomaviruses (PyVs) were initially described in animals. They have also been detected in humans with some evidence that could play a role in skin carcinogenesis. OBJECTIVES: This study aimed to verify the presence of PyVs in different skin tumour samples and to make clinical correlations with patients' epidemiological data from Clinics Hospital of Medical School of University of São Paulo, Brazil. METHODS: This is a cross-sectional study. A random selection was performed of 120 patients with histopathological exams of different cutaneous neoplasms equally divided into 6 groups and 20 patients with normal skin. The available skin specimens were analysed with 2 different techniques of PCR (conventional and real time) for detection of PyV DNA. Concomitantly, retrospective analysis of the respective medical records for the collection of epidemiological data was done. Analyses suitable for categorical data were used to compare the proportion of patients in each group. RESULTS: PyV DNA was found in 25.69% of the samples: 15% in basal cell carcinoma group, 15% in squamous cell carcinoma, 28.57% in melanoma, 15% in dermatofibrosarcoma protuberans, 13.33% in Kaposi sarcoma, 65% in Merkel cell carcinoma (MCC), and none in normal skin. Merkel cell PyV detection was statistically significant in MCC patients (p value <0.01), but no correlations were found between PyVs and others skin tumours. CONCLUSION: This study demonstrated the presence of PyVs in different skin tumours; however, no association of any PyVs found in any skin tumour with epidemiological data could be shown. Further studies are still needed to elucidate the mechanisms of PyVs in skin carcinogenesis.
Assuntos
Carcinoma de Célula de Merkel , Poliomavírus das Células de Merkel , Infecções por Polyomavirus , Polyomavirus , Neoplasias Cutâneas , Animais , Estudos Transversais , Humanos , Polyomavirus/genética , Infecções por Polyomavirus/epidemiologia , Estudos Retrospectivos , Neoplasias Cutâneas/epidemiologiaRESUMO
Solid organ transplant recipients (SOTRs) are susceptible to various cutaneous side effects as a consequence of long-term immunosuppressive therapy. Skin cancers and infections are well-studied complications that can cause death and/or allograft rejection. Other cutaneous drug reactions, such as inflammatory manifestations, have a high prevalence but are rarely studied. We analyzed these manifestations' prevalence and their association with immunosuppressants in transplant recipients from a Brazilian tertiary center. Among 532 SOTRs followed at our dermatology clinic, 60 (11.3%) developed some cutaneous adverse reactions to the immunosuppressants, with a median age at transplantation of 50.5 years and a median life span posttransplantation of seven years. Acneiform eruption was the most common drug reaction found (21 patients, 30.4%), followed by diffuse non-scarring alopecia (16 patients, 23.1%), lymphedema (10 patients, 14.5%), gingival hyperplasia (7 patients, 10.1%), hypertrichosis (6 patients, 8.7%) and sebaceous hyperplasia (9 patients, 13.1%). Adequate immunosuppression is an essential prerequisite for successful organ transplantation. In the immediate post-transplant period, significant immunosuppression is needed, but after that, the complications of excessive immunosuppression outweigh the risk of organ rejection. SORTs may present with a broad spectrum of inflammatory and cosmetic findings due to immunosuppressants that can impair life quality.
Assuntos
Erupções Acneiformes/epidemiologia , Alopecia/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Rejeição de Enxerto/tratamento farmacológico , Imunossupressores/efeitos adversos , Linfedema/epidemiologia , Transplante de Órgãos , Pele/patologia , Erupções Acneiformes/etiologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pele/efeitos dos fármacos , Adulto JovemRESUMO
Abstract Reactivation of chronic Trypanosoma cruzi infection in solid organ transplant recipients (SOTRs) has been reported. The patient presented with a 2-week history of two painful erythematous, infiltrated plaques with central ulceration and necrotic crust on the left thigh. She had a history of chronic indeterminate Chagas disease (CD) and had received a kidney transplant before 2 months. Skin biopsies revealed lobular panniculitis with intracellular amastigote forms of T. cruzi. The patient was diagnosed with CD reactivation. Treatment with benznidazole significantly improved her condition. CD reactivation should be suspected in SOTRs living in endemic areas with clinical polymorphism of skin lesions.
Assuntos
Humanos , Feminino , Trypanosoma cruzi , Paniculite , Transplante de Rim/efeitos adversos , Doença de Chagas/diagnóstico , Coxa da PernaRESUMO
BACKGROUND: Global variation in human papillomavirus (HPV) prevalence and persistence may be explained by differences in risk factors, such as sexual activity, oral contraceptive use, and behavioral factors. We evaluated determinants of acquisition and clearance of HPV infection among young women previously unexposed to HPV. METHODS: Five hundred thirty-four women aged 15 to 25 years who were cytology and HPV DNA negative, and seronegative for anti-HPV-16/18 antibodies, were recruited (July 2000-September 2001) from study centers in Brazil, the United States, and Canada (NCT00689741/NCT00120848). They were followed up for 76 months. Cervical samples were HPV genotyped via polymerase chain reaction. We used multivariable (forward stepwise, P = 0.15) Cox proportional hazards regression to estimate rate ratios (RR) and 95% confidence intervals (CI), separately according to length of follow-up time. RESULTS: On short-term follow-up (0-27 months), 257 (48%; 8535.80 person-months; incidence rate = 30.11; 95% CI, 26.64-34.02) incident HPV infections were detected. Marital status, lifetime number of sex partners, history of any sexually transmitted disease, and occasional use of oral contraceptives were strongly associated with acquisition of any HPV. Having 2 or more lifetime sex partners (RR, 2.03; 95% CI, 1.37-3.02) and a history of any sexually transmitted disease (RR, 1.98; 95% CI, 1.19-3.29) were the most important determinants of high-risk HPV (hrHPV) incidence. During the entire follow-up (0-76 months), an increased hrHPV clearance was found among women in North America (RR, 1.38; 95% CI, 1.08-1.78) and black women (RR, 1.64; 95% CI, 1.04-2.60). Greater number of lifetime partners was associated with reduced clearance rates for any HPV (RR, 0.65; 95% CI, 0.43-0.98). CONCLUSIONS: We identified variation in risk of HPV acquisition and clearance among women unexposed to HPV at baseline.
Assuntos
Colo do Útero/virologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Adolescente , Adulto , Brasil , Canadá , Estudos de Coortes , Método Duplo-Cego , Feminino , Genótipo , Humanos , Incidência , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Prevalência , Fatores de Risco , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Estados Unidos , Adulto JovemRESUMO
Abstract: The oncogenic role of high-risk HPV in anogenital, head and neck, and cervical cancer is well recognized, but not in skin cancer in the general population. Some authors have demonstrated their appearance mainly on the hands and feet, particularly in the area of the nail bed, which could be due to contamination with HPV types from anogenital regions. Here, we describe a case of genital HPV associated with SCC on the nose tip in an immunocompetent young man, which was confirmed by histopathological findings and in situ hybridization. The importance of this report is to highlight the potential role of HPV in the etiology of skin cancer in an immunocompetent individual.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/virologia , Carcinoma de Células Escamosas/virologia , Neoplasias Nasais/virologia , Infecções por Papillomavirus/complicações , Imunocompetência , Neoplasias Cutâneas/imunologia , Neoplasias Cutâneas/patologia , Carcinoma de Células Escamosas/imunologia , Carcinoma de Células Escamosas/patologia , Neoplasias Nasais/imunologia , Neoplasias Nasais/patologia , Infecções por Papillomavirus/patologia , Doenças dos Genitais Masculinos/patologia , Doenças dos Genitais Masculinos/virologiaRESUMO
The oncogenic role of high-risk HPV in anogenital, head and neck, and cervical cancer is well recognized, but not in skin cancer in the general population. Some authors have demonstrated their appearance mainly on the hands and feet, particularly in the area of the nail bed, which could be due to contamination with HPV types from anogenital regions. Here, we describe a case of genital HPV associated with SCC on the nose tip in an immunocompetent young man, which was confirmed by histopathological findings and in situ hybridization. The importance of this report is to highlight the potential role of HPV in the etiology of skin cancer in an immunocompetent individual.
Assuntos
Carcinoma de Células Escamosas/virologia , Imunocompetência , Neoplasias Nasais/virologia , Infecções por Papillomavirus/complicações , Neoplasias Cutâneas/virologia , Carcinoma de Células Escamosas/imunologia , Carcinoma de Células Escamosas/patologia , Doenças dos Genitais Masculinos/patologia , Doenças dos Genitais Masculinos/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Nasais/imunologia , Neoplasias Nasais/patologia , Infecções por Papillomavirus/patologia , Neoplasias Cutâneas/imunologia , Neoplasias Cutâneas/patologiaRESUMO
In the 21st century, despite increased globalization through international travel for business, medical volunteerism, pleasure, and immigration/refugees into the United States, there is little published in the dermatology literature regarding the cutaneous manifestations of helminth infections. Approximately 17% of travelers seek medical care because of cutaneous disorders, many related to infectious etiologies. This review will focus on the cutaneous manifestations of helminth infections and is divided into 2 parts: part I focuses on nematode infections, and part II focuses on trematode and cestode infections. This review highlights the clinical manifestations, transmission, diagnosis, and treatment of helminth infections. Nematodes are roundworms that cause diseases with cutaneous manifestations, such as cutaneous larval migrans, onchocerciasis, filariasis, gnathostomiasis, loiasis, dracunculiasis, strongyloidiasis, ascariasis, streptocerciasis, dirofilariasis, and trichinosis. Tremadotes, also known as flukes, cause schistosomiasis, paragonimiasis, and fascioliasis. Cestodes (tapeworms) are flat, hermaphroditic parasites that cause diseases such as sparganosis, cysticercosis, and echinococcus.
Assuntos
Antinematódeos/uso terapêutico , Nematoides/isolamento & purificação , Infecções por Nematoides/diagnóstico , Infecções por Nematoides/epidemiologia , Dermatopatias Parasitárias/diagnóstico , Dermatopatias Parasitárias/epidemiologia , Animais , Biópsia por Agulha , Progressão da Doença , Doenças Endêmicas , Feminino , Helmintíase/diagnóstico , Helmintíase/tratamento farmacológico , Helmintíase/epidemiologia , Helmintos/isolamento & purificação , Humanos , Imuno-Histoquímica , Incidência , Masculino , Infecções por Nematoides/tratamento farmacológico , Prognóstico , Medição de Risco , Dermatopatias Parasitárias/terapia , Resultado do Tratamento , Clima TropicalRESUMO
In the 21st century, despite increased international travel for vacation, work, and medical missions and immigration into the United States, there is little published in the dermatology literature regarding the cutaneous manifestations of helminth infections. It has been estimated that 20% to 70% of international travelers suffer from some travel-related health problem. Approximately 17% of travelers seek medical care because of cutaneous disorders, many related to infectious etiologies. This review will focus on cutaneous diseases caused by helminth infections. Part I of the review focused on nematode infections; part II will focus on trematode and cestode infections. Nematodes are roundworms that cause diseases with cutaneous manifestations, such as cutaneous larval migrans, onchocerciasis, filariasis, gnathostomiasis, loiasis, dracunculiasis, strongyloidiasis, ascariasis, streptocerciasis, dirofilariasis, and trichinosis. Tremadotes, also known as flukes, cause schistosomiasis, paragonimiasis, and fascioliasis. Cestodes (tapeworms) are flat, hermaphroditic parasites that cause diseases such as sparganosis, cysticercosis, and echinococcus.
Assuntos
Infecções por Cestoides/diagnóstico , Infecções por Cestoides/epidemiologia , Infecções por Trematódeos/diagnóstico , Infecções por Trematódeos/epidemiologia , Animais , Anticestoides/uso terapêutico , Antiplatelmínticos/uso terapêutico , Biópsia por Agulha , Cestoides/isolamento & purificação , Infecções por Cestoides/tratamento farmacológico , Progressão da Doença , Doenças Endêmicas , Feminino , Humanos , Imuno-Histoquímica , Incidência , Larva Migrans/diagnóstico , Larva Migrans/tratamento farmacológico , Larva Migrans/epidemiologia , Masculino , Doenças Raras , Medição de Risco , Dermatopatias Parasitárias/diagnóstico , Dermatopatias Parasitárias/tratamento farmacológico , Dermatopatias Parasitárias/epidemiologia , Viagem , Resultado do Tratamento , Trematódeos/isolamento & purificação , Infecções por Trematódeos/tratamento farmacológico , Clima TropicalRESUMO
BACKGROUND: Epidermodysplasia verruciformis (EV) is a rare genodermatosis caused by specific human papillomavirus (HPV) types associated with the development of multiple squamous cell carcinomas (SCC). The treatment for this skin tumour may be difficult. Among the therapy options, radiotherapy (RT) should be avoided due to its deleterious effects on HPV-induced carcinogenesis. OBJECTIVE: To describe 4 patients with EV who underwent radiotherapy to treat cutaneous SCC. METHODS: This is a retrospective study. The evolution of cutaneous SCC after adjuvant radiotherapy in 4 patients with EV was observed. RESULTS: This study included 4 patients with diagnosis of EV. All 4 of the patients had cutaneous SCC. They underwent surgical resection and adjuvant radiotherapy. Over a period of up to 2 years, there was aggressive tumour recurrence. CONCLUSION: Radiotherapy might be associated with progression of SCC in patients with EV, and it is recommended that radiotherapy should be avoided in this patient population.
Assuntos
Carcinoma de Células Escamosas/virologia , Epidermodisplasia Verruciforme/etiologia , Neoplasias Cutâneas/virologia , Adulto , Carcinoma de Células Escamosas/radioterapia , Epidermodisplasia Verruciforme/diagnóstico , Epidermodisplasia Verruciforme/patologia , Feminino , Humanos , Masculino , Radioterapia/efeitos adversos , Estudos Retrospectivos , Neoplasias Cutâneas/radioterapiaRESUMO
BACKGROUND: Plaque psoriasis is a debilitating skin condition that affects approximately 2% of the adult population and for which there is currently no cure. Tofacitinib is an oral Janus kinase inhibitor that is being investigated for psoriasis. METHODS: The design of this study has been reported previously (NCT00678210). Patients with moderate to severe chronic plaque psoriasis received tofacitinib (2 mg, 5 mg, or 15 mg) or placebo, twice daily, for 12 weeks. Lymphocyte sub-populations, cytomegalovirus (CMV) and Epstein-Barr virus (EBV) DNA were measured at baseline and up to Week 12. RESULTS: Tofacitinib was associated with modest, dose-dependent percentage increases from baseline in median B cell count at Week 4 (24-68%) and Week 12 (18-43%) and percentage reductions from baseline in median natural killer cell count at Week 4 (11-40%). The proportion of patients with detectable CMV and EBV DNA (defined as >0 copies/500 ng total DNA) increased post-baseline in tofacitinib-treated patients. However, multivariate analyses found no relationship between changes in CMV or EBV viral load and changes in lymphocyte sub-populations or tofacitinib treatment. CONCLUSIONS: Twelve weeks of treatment with tofacitinib had no clinically significant effects on CMV or EBV viral load, suggesting that lymphocyte sub-populations critical to the response to chronic viral infections and viral reactivation were not significantly affected. Replication of these findings during long-term use of tofacitinib will allow confirmation of this observation.
Assuntos
Citomegalovirus/fisiologia , Herpesvirus Humano 4/fisiologia , Subpopulações de Linfócitos/efeitos dos fármacos , Piperidinas/uso terapêutico , Inibidores de Proteínas Quinases/uso terapêutico , Psoríase/tratamento farmacológico , Pirimidinas/uso terapêutico , Pirróis/uso terapêutico , Carga Viral/efeitos dos fármacos , Adulto , Proteína C-Reativa/metabolismo , DNA Viral/sangue , Relação Dose-Resposta a Droga , Feminino , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Piperidinas/administração & dosagem , Inibidores de Proteínas Quinases/administração & dosagem , Psoríase/imunologia , Psoríase/virologia , Pirimidinas/administração & dosagem , Pirróis/administração & dosagemAssuntos
Eritema/diagnóstico , Leishmaniose Mucocutânea/diagnóstico , Doenças Nasais/diagnóstico , Adulto , Gluconato de Antimônio e Sódio/uso terapêutico , Antiprotozoários/uso terapêutico , Diagnóstico Diferencial , Eritema/etiologia , Humanos , Leishmaniose Mucocutânea/complicações , Leishmaniose Mucocutânea/tratamento farmacológico , Masculino , Doenças Nasais/etiologia , Viagem , Árvores , VenezuelaRESUMO
BACKGROUND: The increasing prevalence of antimicrobial resistance in Propionibacterium acnes poses a significant challenge to successful treatment outcomes in acne patients. Although P. acnes resistance has been demonstrated throughout the world, no previous data regarding the antimicrobial susceptibility of P. acnes in Colombia are available. OBJECTIVES: The aim of this study was to determine the antimicrobial susceptibility of P. acnes to common antibiotics used in the treatment of acne in a Colombian population. METHODS: Samples were collected from facial acne lesions of 100 dermatology patients. All samples were cultured in anaerobic conditions, and final identification of isolates was performed. Isolates of P. acnes were then subjected to antimicrobial susceptibility tests using erythromycin, clindamycin, tetracycline, doxycycline, and minocycline. RESULTS: Propionibacterium acnes isolates resistant to erythromycin (35%), clindamycin (15%), doxycycline (9%), tetracycline (8%), and minocycline (1%) were observed. Isolates with cross-resistance were also observed (to erythromycin and clindamycin [12%] and to doxycycline and tetracycline [6%]). Overall, 46% of isolates taken from patients with a history of antibiotic use demonstrated resistance, whereas 29% of isolates taken from patients who had never used antibiotics demonstrated resistance. CONCLUSIONS: Antimicrobial resistance in P. acnes in this Colombian population has a lower prevalence than those reported in Europe and follows a similar pattern to findings elsewhere in Latin America. Resistance is demonstrated even in isolates from patients with no previous history of antibiotic use. Resistance to erythromycin is most commonly observed. Minocycline emerges as the most effective antibiotic.
Assuntos
Acne Vulgar/tratamento farmacológico , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Propionibacterium acnes/efeitos dos fármacos , Acne Vulgar/epidemiologia , Acne Vulgar/microbiologia , Adolescente , Adulto , Criança , Colômbia/epidemiologia , Dermatite/tratamento farmacológico , Dermatite/epidemiologia , Feminino , Infecções por Bactérias Gram-Positivas/epidemiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Prevalência , Adulto JovemRESUMO
Although many tropical insects carry infectious diseases, cutaneous injury can occur by other mechanisms, for example erucism (envenomation by caterpillars) or lepidopterism (dermatitis from moths). Pararama is a unique form of erucism seen in workers in contact with rubber trees in the Amazon, and it is caused by Premolis larvae, resulting in progressive periarticular fibrosis, ankylosis, and the loss of articulation. Ants and aquatic insects of the Belostomatidae family can cause painful bites and stings. Anaphylactic shock and death can result from the venom of bees and wasps. Beetles can cause vesicular dermatitis via cantharidin or paederin. Myiasis results from fly larvae (maggots) feeding on live or necrotic tissue of humans or other hosts, while New World screwworm fly larvae feed only on living tissue and burrow (ie, screw) more deeply when attempts are made to remove them. Tungiasis is characterized by very pruritic and painful papules and ulcers resulting from a Tunga flea penetrating the host's skin. Dermatologists should be able to diagnose and treat the cutaneous manifestations of these tropical insects and educate their patients on prevention.
Assuntos
Venenos de Artrópodes/efeitos adversos , Dermatopatias Parasitárias , Pele/patologia , Animais , Percevejos-de-Cama , Humanos , Himenópteros , Lepidópteros , Necrose , Infecção por Mosca da Bicheira , Pele/efeitos dos fármacos , Pele/parasitologia , Dermatopatias Parasitárias/diagnóstico , Dermatopatias Parasitárias/terapia , TungíaseRESUMO
Members of arthropod classes Chilopoda (centipedes), Diplopoda (millipedes), and Arachnida (spiders and scorpions) cause tissue injury via bites, stings, and/or a release of toxins. A few members of the Acari subclass of Arachnida (mites and ticks) can transmit a variety of infectious diseases, but this review will cover the noninfectious manifestations of these vectors. Dermatologists should be familiar with the injuries caused by these arthropods in order to initiate proper treatment and recommend effective preventative measures.
Assuntos
Venenos de Artrópodes , Dermatopatias Parasitárias , Pele/parasitologia , Animais , Aracnídeos , Humanos , Escabiose , Escorpiões , Dermatopatias Parasitárias/diagnóstico , Dermatopatias Parasitárias/terapia , Venenos de Aranha , AranhasRESUMO
To determine the prevalence of cervical human papillomavirus (HPV) infection and risk factors in young women from Brazil, Canada, and the USA. Cross-sectional study in 3204 healthy women, aged 15 to 25 years. Cervical samples were collected for cytology and for HPV DNA detection (SPF 10-LiPA 25 system). Serum samples were collected for the measurement of HPV-16 and HPV-18 antibodies by enzyme-linked immunosorbent assay. Risk factors were obtained through a questionnaire. Overall, 26.6% of women had DNA detected for at least 1 HPV type. The prevalence for oncogenic HPV types was 21.7% (25% in Brazil, 16.9% in Canada, and 19.1% in the USA). HPV-16 was the most prevalent oncogenic type (5.2%). The next most common oncogenic HPV types were 51 (3.3%), 52 (3.3%), 31 (2.9%), 66 (2.3%), and 39 (2.0%). Multiple oncogenic types were detected in one-third of the infections. The prevalence of HPV-16 and/or HPV-18 infections detected by DNA and/or enzyme-linked immunosorbent assay was 24.8%. The majority of women (85%) had a normal cervical cytology. Sexual behavior was the main determinant for HPV-16/18 infections and squamous intraepithelial lesions. The prevalence of HPV oncogenic infections was high and linked to sexual behavior. Strategies to reduce the burden of oncogenic HPV infection, such as prophylactic vaccination programs, are likely to impact the burden of disease due to cervical precancer and cancer.