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Introducción: Los diabéticos muestran una disminuida función del sistema inmune. Su complicación más temida es la aparición de las úlceras del pie. El Heberprot-P® tiene efectos beneficiosos en la curación de estas úlceras. Objetivo: Evaluar el efecto de la inmunidad celular en el tratamiento de las úlceras del pie diabético con Heberprot-P®. Métodos: Se realizó un estudio observacional, prospectivo, de serie de casos, en 30 pacientes con úlcera de pie diabético, ingresados en el Instituto Nacional de Angiología y Cirugía Vascular. Se administraron 75 µg de Heberprot-P®, tres veces por semana, a través de vías peri- e intralesional, durante ocho semanas. Se evaluaron las variables edad, sexo, glucemia en ayunas, creatinina, urea, ácido úrico, prueba de hipersensibilidad retardada, porcentaje de granulación, tiempo de cierre de la lesión y localización de la úlcera, antes de comenzar el tratamiento, a las 4 y 8 semanas. Resultados: Se precisó un predominio del 60 por ciento en el sexo femenino y del color de piel blanca. Los niveles de glucemia y creatinina se comportaron más elevados en los anérgicos; la urea fue similar tanto en anérgicos como en reactivos; y el ácido úrico resultó mayor en hombres reactivos y en mujeres anérgicas. Hubo mayor proporción de reactivos (63,6 por ciento), que en la cuarta semana presentaron un tejido de granulación igual o mayor al 50 por ciento; y a la octava, igual o mayor al 70 por ciento. Conclusiones: La condición en los pacientes diabéticos de ser reactivo a las pruebas de hipersensibilidad retardada con úlcera de pie diabético de tipo neuropática, tratados con Heberprot-P®, está asociada directamente con una mejor respuesta en la cicatrización de sus lesiones, mediante la formación del tejido de granulación, que favorece el cierre total o parcial de la lesión. Esto no ocurrió con los pacientes anérgicos a dicha prueba(AU)

Introduction: Diabetics show decreased immune system function. Its most feared complication is the appearance of foot ulcers. Heberprot-P® has beneficial effects in healing these ulcers. Objective: To assess the effect of cellular immunity in the treatment of diabetic foot ulcers with Heberprot-P®. Methods: An observational, prospective, case series study was conducted in 30 patients with diabetic foot ulcer admitted to the National Institute of Angiology and Vascular Surgery. 75 µg of Heberprot-P®, three times a week, were administered through peri- and intralesional routes, during eight weeks. The variables age, sex, fasting blood glucose, creatinine, urea, uric acid, delayed hypersensitivity test, percentage of granulation, time of closure of the lesion and location of the ulcer, before starting treatment, at 4 and 8 weeks were evaluated. Results: A predominance of 60 % in females and white skin color were specified. Blood glucose and creatinine levels behaved higher in the anergics; urea was similar in both anergics and reagents; and uric acid was higher in reactive men and anergic women. There was a higher proportion of reagents (63.6 por ciento), which in the fourth week presented a granulation tissue equal to or greater than 50 por ciento; and at the eighth week, it was equal to or greater than 70 por ciento. Conclusions: The condition of being reactive to delayed hypersensitivity tests in diabetic patients with diabetic foot ulcer of neuropathic type, treated with Heberprot-P® is directly associated with a better response in the healing of their lesions, through the formation of granulation tissue, which favors the total or partial closure of the lesion. This did not occur with patients who were anergic to this test(AU)

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INTRODUCTION: Multiform exudative erythema is a rare delayed hypersensitivity reaction associated with medications. The manifestations caused by hydroxychloroquine are exceptional; however, due to the increase in its prescription due to the recent SARS-CoV-2 pandemic, adverse reactions have been exacerbated. CASE REPORT: A 60-year-old female patient, who attended the Emergency Department for a picture of erythematous rash of one week of evolution, with involvement of the trunk, face and palms of the hands. Laboratory studies reported: leukocytosis with neutrophilia and lymphopenia, without eosinophilia or abnormal liver enzymes. The lesions continued to descend towards her extremities, with subsequent desquamation. She was prescribed prednisone 15 mg/24 h for three days, tapering to 10 mg/24 h, until her new assessment, in addition to antihistamines. Two days later, new macular lesions appeared in the presternal area and on the oral mucosa. Control laboratory studies did not show alterations. Skin biopsy reported: vacuolar interface dermatitis with spongiosis and parakeratosis, compatible with erythema multiforme. Epicutaneous tests were carried out with meloxicam and 30% hydroxychloroquine in water and vaseline, occluded for two days and interpreted at 48 and 96 hours, with a positive result for the latter. The diagnosis of multiform exudative erythema due to hydroxychloroquine was established. CONCLUSIONS: This study confirms the efficacy of patch tests in patients with delayed hypersensitivity reactions to hydroxychloroquine.

INTRODUCCIÓN: El eritema exudativo multiforme es una reacción de hipersensibilidad retardada poco frecuente asociada con medicamentos. Las manifestaciones provocadas por hidroxicloroquina son excepcionales; sin embargo, debido al incremento de su prescripción, por la reciente pandemia de SARS-CoV-2, las reacciones adversas se han exacerbado. REPORTE DE CASO: Paciente femenina de 60 años, que acudió al servicio de Urgencias por un cuadro de exantema eritematoso de una semana de evolución, con afectación hacia el tronco, la cara y las palmas de las manos. Los estudios de laboratorio informaron: leucocitosis con neutrofilia y linfopenia, sin eosinofilia ni alteración de las enzimas hepáticas. Las lesiones continuaron descendiendo hacia las extremidades, con posterior descamación. Se le indicó prednisona 15 mg/24 h durante tres días, con disminución a 10 mg/24 h, hasta su nueva valoración, además de antihistamínicos. Dos días posteriores aparecieron nuevas lesiones maculares en la zona preesternal y en la mucosa oral. Los estudios de laboratorio de control no mostraron alteraciones. La biopsia cutánea informó: dermatitis de interfase vacuolar con espongiosis y paraqueratosis, compatible con eritema multiforme. Se llevaron a cabo pruebas epicutáneas con meloxicam e hidroxicloroquina al 30% en agua y vaselina, ocluidos dos días e interpretados a las 48 y 96 horas, con resultado positivo para esta última. Se estableció el diagnóstico de eritema exudativo multiforme por hidroxicloroquina. CONCLUSIONES: Este estudio confirma la eficacia de las pruebas epicutáneas en pacientes con reacciones de hipersensibilidad retardada a hidroxicloroquina.

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Brazil ranked second in the world for the number of aesthetic procedures carried out in 2019. Five case reports of delayed hypersensitivity reaction to hyaluronic acid dermal filler after COVID-19 vaccination are presented in this paper. Additional vaccination for new variants, including omicron, will be necessary; therefore, aesthetic professionals should be aware of this possibility and advise patients accordingly.

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INTRODUCTION: The aim of this report is to present a clinical case of oral lichenoid lesions associated with amalgam restorations with the presence of desquamative gingivitis for a nine months follow up period. CASE REPORT: The histopathologic characteristics and direct immunofluorescence were compatible with Oral Lichenoid Lesion (LLO). Diagnosis was based on a synthesis of all available information, including medical history, clinical examination, histopathology and the results of specific tests, such as the patch test, which confirmed allergy to thimerosal, an organic compound of mercury. DISCUSSION: The replacement of amalgam restorations has brought improvements to the instrument, as evidenced by the disappearance of desquamative gingivitis, aspect erythematosus and erosive lesions. The fading does not complete the same, however, indicates the need to continue has been under continuous observation, the patient, having in view the possibility of the existence of an underlying lichen planus.

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Dimenidrinato é um anti-histamínico H1 do grupo das etanolaminas, com importantes propriedades anticolinérgicas, antisserotoninérgicas e sedativas. Relatamos um caso de uma mulher que após 14 dias de ter usado dimenidrinato, iniciou quadro de exantema e vasculite urticariforme, além de sintomas constitucionais. Avaliação laboratorial sem alterações. Biopsia de pele evidenciou dermatite de interface do tipo vacuolar e púrpura com leucocitoclasia e derrame pigmentar. Imunofluorescência positiva para IgG, com presença de fluorescência dos núcleos dos queratinócitos da epiderme. Tratada com corticoide oral por 2 meses até remissão completa do quadro, e posterior realização de teste intradérmico, que foi positivo na leitura de 48h. A reação de hipersensibilidade tardia observada foi relacionada a mecanismo misto de Gell e Coombs (III e IV), com positividade no teste cutâneo intradérmico de leitura tardia em 48h (reação tipo IV) e biópsia compatível com vasculite cutânea (reação tipo III); lesões exantemáticas (reação tipo IV) e urticária vasculítica (reação tipo III). O teste cutâneo com dimenidrinato positivo reforça o diagnóstico de reação de hipersensibilidade.

Dimenhydrinate is an H1 antihistamine from the ethanolamine group, with important anticholinergic, antiserotoninergic and sedative properties. We report the case of a woman who, after 14 days of using dimenhydrinate, developed rash and urticarial vasculitis, in addition to constitutional symptoms. Laboratory tests were normal. Skin biopsy revealed interface purpuric dermatitis with leukocytoclasia and pigment effusion. Immunofluorescence was positive for IgG, showing nuclear fluorescence of epidermal keratinocytes. She was treated with oral corticosteroid for 2 months until complete remission of symptoms. Subsequent intradermal test resulted positive on the 48-h reading. The delayed hypersensitivity reaction was related to a mixed Gell and Coombs mechanism (III and IV), with positive results in the intradermal cutaneous test on the 48-h reading (type IV reaction) and a biopsy compatible with cutaneous vasculitis (type III reaction), exanthematous lesions (type IV reaction,) and urticarial vasculitis (type III reaction). The positive skin test for dimenhydrinate reinforces the diagnosis of hypersensitivity reaction.

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Acute infection with Trypanosoma cruzi results in intense myocarditis, which progresses to a chronic, asymptomatic indeterminate form. The evolution toward this chronic cardiac form occurs in approximately 30% of all cases of T. cruzi infection. Suppression of delayed type hypersensitivity (DTH) has been proposed as a potential explanation of the indeterminate form. We investigated the effect of cyclophosphamide (CYCL) treatment on the regulatory mechanism of DTH and the participation of heart interstitial dendritic cells (IDCs) in this process using BALB/c mice chronically infected with T. cruzi. One group was treated with CYCL (20 mg/kg body weight) for one month. A DTH skin test was performed by intradermal injection of T. cruzi antigen (3 mg/mL) in the hind-footpad and measured the skin thickness after 24 h, 48 h and 72 h. The skin test revealed increased thickness in antigen-injected footpads, which was more evident in the mice treated with CYCL than in those mice that did not receive treatment. The thickened regions were characterised by perivascular infiltrates and areas of necrosis. Intense lesions of the myocardium were present in three/16 cases and included large areas of necrosis. Morphometric evaluation of lymphocytes showed a predominance of TCD8 cells. Heart IDCs were immunolabelled with specific antibodies (CD11b and CD11c) and T. cruzi antigens were detected using a specific anti-T. cruzi antibody. Identification of T. cruzi antigens, sequestered in these cells using specific anti-T. cruzi antibodies was done, showing a significant increase in the number of these cells in treated mice. These results indicate that IDCs participate in the regulatory mechanisms of DTH response to T. cruzi infection.

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Tridax procumbens L., Asteraceae, has been extensively used in Ayurvedic system of medicine for various ailments. Previous studies on the extracts of T. procumbens revealed remarkable immunomodulatory activity of TPEIF (T. procumbens ethanol insoluble fraction) extract. The dried methanol extract of T. procumbens was dissolved in distilled water, and then fractioned by re-extracting with chloroform, ethyl acetate and n-butanol subsequently. Immunomodulatory activities of these fractions were determined in vivo. The amounts of total phenolic compounds were also determined. Ethyl acetate and n-butanol fractions showed the significant immunomodulary activity. However, the ethyl acetate fraction exhibited the highest total phenolic content. Therefore, ethyl acetate fraction was subjected to further separation by chromatographic methods. Two phytochemicals SA-3 and SA-4 were obtained by repeated purification in sufficient amount to screen them for the immunomodulatory activity by the in vivo models i.e. neutrophil adhesion and delayed type hypersensitivity. In addition, the n-butanol fraction was subjected to silica gel column chromatography (CC); SA-6 was isolated from it. Mice were treated with two doses of SA-3, SA-4 and SA-6 (2 and 4 mg/kg) for fifteen days. Immune responses to T-dependent antigen SRBCs were observed using parameters like DTH and Neutrophil adhesion. Overall, SA-4 and SA-6 showed dose relative immunostimulatory effect on in vivo immune functions in mice. From these results, it can be suggested that these compounds may be used as potential immunostimulators. The structures of isolated phytochemicals were determined by UV, IR, NMR, and MS spectroscopic methods.

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Infecções hospitalares estão entre as principais complicações associadas a óbito em Unidade de Terapia Intensiva(UTI). Entretanto, existem poucas ferramentas validadas em UTI para tentar caracterizar o risco de tais complicações. Objetivo: Caracterizar a resposta a testes cutâneos de hipersensibilidade tardia no momento da admissão de pacientes em UTI, relacionando-a ao desenvolvimento de infecção hospitalar. Pacientes e métodos: Foram analisadas as respostas dos testes cutâneos (pápulas formadas) para quatro antígenos: PPD, candidina, tricofitina e estreptoquinase em 78 pacientes, à admissão em UTI. Os pacientes foram divididos em três grupos: A) sem infecção na admissão e durante a internação; B)sem infecção na admissão e que desenvolveram infecção durante a internação; C) infecção diagnosticada na admissão. Foram ainda divididos em: eutróficos, obesos e desnutridos. Resultados: Tanto pacientes que desenvolveram infecção na UTI (24 pacientes) quanto aqueles que já apresentavam infecção à admissão (15 pacientes) apresentaram menor positividade dos testes ao PPD (1,75 e 0,53mm) e à candidina (1,45 e 1,06mm), quando comparados a 34 pacientes que nãodesenvolveram infecção (4,97 para PPD e 4,74mm para candidina)(p<0,05). Observou-se ainda que os 40 desnutridos apresentaram menor positividade à candidina (1,91mm) quando comparados aos 21 eutróficos (3,17mm) (p<0,05). Conclusão: Observamos que pacientes com diagnóstico de infecção à internação em UTI e os que evoluíram para infecção na UTI apresentaram uma menor resposta aos testes cutâneos de hipersensibilidade tardia ao PPD e à candidina. Acreditamos que a aplicação dos testes cutâneos possa ser uma ferramenta útil na avaliação de risco de infecção hospitalar em UTI.

The hospital infections are among the major complications associated with death in the Intensive Care Unit (ICU). However, there are few validated tools in the ICU to try to characterize the risk of such complications. Objective: To characterize the response to skin tests for delayed hypersensitivity at the time of admission of patients inthe ICU and its relation to the development of nosocomial infection. Patients and Methods: We analyzed the responses of skin tests (papules formed) to four antigens: PPD, candidina, trichophytinand streptokinase in 78 patients at the ICU admission. Patients were divided into three groups: A) no infection at admission and during hospitalization; B) without infection on admission and who developed infections during hospitalization; C) infection diagnosed on admission. Patients were further divided into: normal weight, obese and malnourished. Results: The patients that developed infections in the ICU(24 patients) and those that already had infection on admission(15 patients) had lower positivity to PPD (1.75 and 0.53mm) and candidina tests (1.45 and 1.06mm), when they were compared to 34 patients without infection (4.97 for PPD and 4.74mm for candidina) (p<0.05). It was also observed that the 40 malnourished patients had lower positivity for candidina (1.91 mm) when they were compared to 21 normal weight(3,17mm) (p<0.05). Conclusion: We found that patients with a diagnosis of infection at admission in the ICU and who progressed to infection in the ICU had a lower response to skin tests for delayed hypersensitivity to PPD and candidina. We believe that the application of skin tests may be a useful tool in assessing risk of nosocomial infection in ICU.

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