RESUMO
Introduction: Chikungunya virus is spreading worldwide due to migration and globalization and could be presented with systemic and with unusual symptoms. Objective: To report a case of virus-transmitted infection detected in a woman during the gynecological examination at a vulvar clinic. Case report: A 73-year-old Caucasian woman attended a vulvar clinic because of dyspareunia and vulvar burning. Ulcers were observed on labia minora and perineum. A Chikungunya was diagnosed by seroconversion in paired specimens. She was prescribed prednisolone 40 mg once a day for 10 days. After oral steroid treatment, the woman had no body rashes or lesions on her genitals. Conclusion: This study emphasized that rare signs of unusual vulvitis with ulcers could be associated with Chikungunya infection.
Introdução: O vírus Chikungunya está se espalhando pelo mundo por conta da migração e da globalização, podendo apresentar sintomas sistêmicos e incomuns. Objetivo: Relatar um caso de infecção pelo vírus detectado em uma mulher por ocasião do exame ginecológico em clínica de patologia vulvar. Relato do caso: Uma mulher caucasiana de 73 anos foi a uma clínica vulvar por causa de dispareunia e queimação vulvar. Úlceras foram observadas nos pequenos lábios e no períneo. O diagnóstico de Chikungunya foi realizado por soroconversão em espécimes pareados. Foi prescrita prednisolona 40 mg uma vez ao dia por dez dias. Após o tratamento com esteróides orais, a mulher não apresentou erupções ou lesões nos órgãos genitais. Conclusão: Este estudo enfatizou que quadros raros de vulvite com úlcera podem estar associados à infecção por Chikungunya.
Assuntos
Humanos , Feminino , Idoso , Úlcera/virologia , Vulvite/virologia , Febre de Chikungunya/complicações , Exame GinecológicoRESUMO
The Epstein-Barr virus (EBV)-positive mucocutaneous ulcer is a rare entity in the spectrum of lymphoproliferative diseases associated with the EBV. It occurs typically in patients with immunosuppression associated with immunosenescence, as well as due to iatrogenic causes, posttransplant patients and primary immunodeficiency disorders. It is often a benign and self-limited disease that recedes by stopping or reducing the immunosuppressive agents in most of the cases. Histologically, it is characterized by a population of EBV-positive atypical lymphoid cells. Here, we present a rare case of a 5-month-old pediatric patient, born preterm at 24 weeks of gestational age, presenting a lump on the right shoulder, later evolving to EBV-positive mucocutaneous ulcer.
Assuntos
Infecções por Vírus Epstein-Barr/diagnóstico , Infecções por Vírus Epstein-Barr/imunologia , Hospedeiro Imunocomprometido , Transtornos Linfoproliferativos/diagnóstico , Transtornos Linfoproliferativos/imunologia , Dermatopatias/diagnóstico , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Transtornos Linfoproliferativos/virologia , Masculino , Dermatopatias/imunologia , Dermatopatias/virologia , Úlcera/diagnóstico , Úlcera/imunologia , Úlcera/virologiaRESUMO
AIM: Lipschütz ulcers (LU) were first described as rare vulvar ulcerations that affect adolescents without previous history of sexual contact. However, more LU patients have been identified in acute genital ulcers (AGU) services in Europe. PURPOSE: To review cases of AGU and analyze the occurrence of LU in the Ob/Gyn Emergency Department of a Brazilian private hospital, using the currently used diagnostic criteria. METHODS: All female patients who sought our service with AGU complaints from January 2009 to July 2015 were selected and had their medical records reviewed, considering the clinical data and some diagnostic criteria, that included: < 20 years old, first AGU episode, sudden onset, absence of sexual contact 3 months before onset and the absence of immunodeficiency. RESULTS: 273 patients eligible for analysis were identified according to the criteria and 12 (4.39%) of them were identified with the possible diagnosis of LU. By applying less restrictive criteria that allowed the inclusion of patients of any age and sexual status, 98 were identified (35.89%). CONCLUSIONS: Despite being described as a rare pathology, ours and previous results indicate a considerable number of AGU cases, suggesting that LU should be better known and considered for differential diagnosis.
Assuntos
Úlcera/diagnóstico , Doenças da Vulva/diagnóstico , Adolescente , Adulto , Idoso , Brasil , Criança , Bases de Dados Genéticas , Diagnóstico Diferencial , Europa (Continente) , Feminino , Herpes Genital/complicações , Herpes Genital/diagnóstico , Humanos , Pessoa de Meia-Idade , Úlcera/patologia , Úlcera/virologia , Doenças da Vulva/patologia , Doenças da Vulva/virologia , Adulto JovemRESUMO
Genital aphthous ulcers can result from multiple conditions including febrile syndromes. Chikungunya infection manifests mainly as fever accompanied by polyarthralgia and pruritic rash. Nevertheless, healthcare providers should be alert to additional presentations. This is the case of a young woman presenting with painful genital ulcers after a three day prodome of fever and polyarthralgia. As a suspected case of Chikungunya infection and a clinical diagnosis of aphthae, treatment with oral prednisone for two weeks produced complete resolution of ulcers with no scarring. It is important to recognize that genital aphthous ulcers can develop in a febrile presentation such as that with Chikungunya. Although sexually transmitted diseases should be ruled out as a more common diagnosis in cases of genital lesions, knowledge about this unusual dermatological presentation would represent not only adequate prompt treatment but will minimize equivocal diagnosis as a sexually transmitted disease.
Assuntos
Febre de Chikungunya/diagnóstico , Doenças dos Genitais Femininos/diagnóstico , Prednisona/uso terapêutico , Úlcera/diagnóstico , Administração Oral , Adulto , Febre de Chikungunya/complicações , Febre de Chikungunya/tratamento farmacológico , Feminino , Doenças dos Genitais Femininos/tratamento farmacológico , Doenças dos Genitais Femininos/virologia , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Prednisona/administração & dosagem , Resultado do Tratamento , Úlcera/tratamento farmacológico , Úlcera/virologiaRESUMO
BACKGROUND: Sexually transmitted diseases (STDs) and in particular genital ulcer disease (GUD) have a major impact on morbidity and mortality in developing countries. The World Health Organization recommends the use of syndromic guidelines for the treatment of sexually transmitted infections (STIs) in resource-constrained countries. Surveillance of autochthonous etiologies provides epidemiological information contributing to the prevention and treatment of STIs. We investigated the etiology and factors associated with GUD among male patients attending a STD clinic in Havana, Cuba. METHODS: Swabs from genital ulcers of 113 male patients, collected from May 2012 to June 2015, were analyzed using PCR for herpes simplex virus types 1 and 2, Treponema pallidum, Haemophilus ducreyi, and Chlamydia trachomatis. We also investigated the clinical and epidemiological characteristics associated with the presence of these pathogens in GUD. RESULTS: At least one of the pathogens was detected in 70% of patients. The occurrence of the pathogens was herpes simplex virus type 2 (HSV-2) (51.3%), T. pallidum (29.2%), and C. trachomatis (1.8%). Co-infections occurred as follows: T. pallidum-HSV-2 (10.6%), C. trachomatis-HSV-2 (0.9%) and C. trachomatis-T. pallidum (0.9%). Herpes simplex virus type 1 and H. ducreyi were not detected. Ages 15 to 40 years, HIV-positive serostatus, and no condom use were significant risk factors for the presence of HSV-2 in genital ulcers. CONCLUSIONS: Our preliminary results highlight the predominance of HSV-2 and T. pallidum as the leading GUD etiologies in the study population and identified risk factors associated with HSV-2. This information should help to inform guidelines for better management of GUD in Havana, Cuba.
Assuntos
Doenças dos Genitais Masculinos/etiologia , Herpesvirus Humano 2/isolamento & purificação , Infecções Sexualmente Transmissíveis/etiologia , Treponema pallidum/isolamento & purificação , Úlcera/etiologia , Adolescente , Adulto , Chlamydia trachomatis/genética , Chlamydia trachomatis/isolamento & purificação , Coinfecção , Cuba/epidemiologia , Doenças dos Genitais Masculinos/epidemiologia , Doenças dos Genitais Masculinos/virologia , Soropositividade para HIV , Haemophilus ducreyi/genética , Haemophilus ducreyi/isolamento & purificação , Herpesvirus Humano 1/genética , Herpesvirus Humano 1/isolamento & purificação , Herpesvirus Humano 2/genética , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/virologia , Treponema pallidum/genética , Úlcera/epidemiologia , Úlcera/virologia , Adulto JovemRESUMO
Esophageal ulcer (EU) represents an important comorbidity in AIDS. We evaluated the prevalence of EU, the accuracy of the endoscopic and histologic methods used to investigate viral EU in HIV-positive Brazilian patients and the numerical relevance of tissue sampling. A total of 399 HIV-positive patients underwent upper gastrointestinal (UGI) endoscopy. HIV-positive patients with EU determined by UGI endoscopy followed by biopsies were analyzed by the hematoxylin-eosin (HE) and immunohistochemical (IH) methods. EU was detected in 41 patients (mean age, 39.2 years; 23 males), with a prevalence of 10.27%. The median CD4 count was 49 cells/mm(3) (range, 1-361 cells/mm(3)) and the viral load was 58,869 copies per milliliter (range, 50-77,3290 copies per milliliter). UGI endoscopy detected 29 of 41 EU suggestive of cytomegalovirus (CMV) infection and 7 of 41 indicating herpes simplex virus (HSV) infection. HE histology confirmed 4 of 29 ulcers induced by CMV, 2 of 7 induced by HSV, and 1 of 7 induced by HSV plus CMV. IH for CMV and HSV confirmed the HE findings and detected one additional CMV-induced case. UGI endoscopy showed 100% sensitivity and 15% specificity for the diagnosis of EU due to CMV or HSV compared to HE and IH. HE proved to be an adequate method for etiologic evaluation, with 87% sensitivity and 100% specificity compared to IH. The number of samples did not influence the etiologic evaluation. The data support the importance of IH as a complementary method for HE in the diagnosis of EU of viral etiology.
Assuntos
Doenças do Esôfago/diagnóstico , Doenças do Esôfago/epidemiologia , Infecções por HIV/complicações , Úlcera/diagnóstico , Úlcera/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adulto , Brasil/epidemiologia , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/virologia , Endoscopia Gastrointestinal , Amarelo de Eosina-(YS) , Doenças do Esôfago/complicações , Doenças do Esôfago/virologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Hematoxilina , Herpes Simples/complicações , Herpes Simples/diagnóstico , Herpes Simples/epidemiologia , Herpes Simples/virologia , Humanos , Imuno-Histoquímica/métodos , Masculino , Pessoa de Meia-Idade , Prevalência , Sensibilidade e Especificidade , Simplexvirus/isolamento & purificação , Úlcera/complicações , Úlcera/virologiaAssuntos
Alphapapillomavirus/patogenicidade , Carcinoma de Células Escamosas/epidemiologia , Controle de Infecções , Infecções por Papillomavirus/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Alphapapillomavirus/classificação , Alphapapillomavirus/genética , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/prevenção & controle , Carcinoma de Células Escamosas/virologia , Cocarcinogênese , Citocinas/metabolismo , Países em Desenvolvimento , Feminino , Predisposição Genética para Doença , Humanos , Imunidade Celular , Imunocompetência , Indígenas Norte-Americanos/estatística & dados numéricos , América Latina/epidemiologia , México/epidemiologia , Pessoa de Meia-Idade , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/transmissão , Vacinas contra Papillomavirus , Comportamento Sexual , Fatores Socioeconômicos , Úlcera/etiologia , Úlcera/virologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/virologia , Cervicite Uterina/etiologia , Cervicite Uterina/virologiaRESUMO
The critical properties of a cellular automaton model describing the spreading of infection of the herpes simplex virus in corneal tissue are investigated through the dynamic Monte Carlo method. The model takes into account different cell susceptibilities to the viral infection, as suggested by experimental findings. In a two-dimensional square lattice the sites are associated with two distinct types of cells, namely, permissive and resistant to the infection. While a permissive cell becomes infected in the presence of a single infected cell in its neighborhood, a resistant cell needs to be surrounded by at least R>1 infected or dead cells in order to become infected. The infection is followed by the death of the cells resulting in ulcers whose forms may be dendritic (self-limited clusters) or amoeboid (percolating clusters) depending on the degree of resistance R of the resistant cells as well as on the density of permissive cells in the healthy tissue. We show that a phase transition between these two regimes occurs only for R>/=5 and, in addition, that the phase transition is in the universality class of the ordinary percolation.
Assuntos
Herpes Simples/metabolismo , Úlcera/patologia , Úlcera/virologia , Gânglios/virologia , Humanos , Modelos Biológicos , Modelos Teóricos , Método de Monte Carlo , Mucosa/virologia , Neurônios/virologia , Simplexvirus/metabolismo , Fatores de TempoAssuntos
Doenças do Colo/virologia , Infecções por Citomegalovirus/congênito , Obstrução Intestinal/virologia , Colite/congênito , Colite/virologia , Doenças do Colo/congênito , Constrição Patológica/congênito , Constrição Patológica/virologia , Humanos , Recém-Nascido , Obstrução Intestinal/congênito , Masculino , Úlcera/congênito , Úlcera/virologiaAssuntos
Infecções por Citomegalovirus/congênito , Doenças do Íleo/virologia , Adulto , Corantes , Feminino , Humanos , Doenças do Íleo/congênito , Técnicas Imunoenzimáticas , Corpos de Inclusão/ultraestrutura , Corpos de Inclusão/virologia , Recém-Nascido , Obstrução Intestinal/congênito , Obstrução Intestinal/virologia , Masculino , Gravidez , Úlcera/congênito , Úlcera/virologiaRESUMO
Thirty five esophageal biopsies from AIDS patients with clinical symptoms of esophagitis sent to "Emilio Ribas Institute", Pathology Laboratory, in a 2 year period were revised for possible infectious agents. Microorganisms were seen in 17 cases (48.6%). In 6 cases (17.1%), Acid-Fast bacilli were observed. One of these cases also had characteristic cytomegalic inclusions in endothelial cells. Inflammatory responses were composed of lymphocytes, some plasma cells and many histiocytes, with absence of giant cells in 4 cases of mycobacteriosis; in the other 2 cases, acid-fast bacilli were seen over the epithelium. Exclusive infection by cytomegalovirus was detected in 5 cases (14.3%), and candidiasis in 5 cases (14.3%). In one case there was association of cytomegalovirus and candidiasis. Esophageal ulcers in AIDS patients caused by Mycobacterium sp, may be more common than previously reported, and certainly an overlooked diagnosis. Once esophageal biopsy is an easy diagnostic procedure, this method may be used in routine screening for tuberculosis in patients with AIDS.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Doenças do Esôfago/etiologia , Esofagite/complicações , Úlcera/etiologia , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/patologia , Adulto , Biópsia , Fístula Brônquica/complicações , Candidíase/complicações , Infecções por Citomegalovirus/complicações , Doenças do Esôfago/microbiologia , Doenças do Esôfago/patologia , Doenças do Esôfago/virologia , Fístula Esofágica/complicações , Esofagite/microbiologia , Esofagite/patologia , Esofagite/virologia , Feminino , Humanos , Masculino , Tuberculose/complicações , Tuberculose/patologia , Úlcera/microbiologia , Úlcera/patologia , Úlcera/virologiaRESUMO
OBJECTIVE: To determine the frequency of asymptomatic perianal shedding of herpes simplex virus (HSV) in adult patients with acquired immunodeficiency syndrome (AIDS). DESIGN: Cross-sectional study. SETTING: A 1000-bed, state-supported hospital in Brazil that provides comprehensive health care. PATIENTS: Eighty-two consecutively hospitalized patients with AIDS (Centers for Disease Control and Prevention class C). MAIN OUTCOME MEASUREMENT: Specimens for HSV culture were obtained with premoistened swabs of the perianal region at approximately 7-day intervals during the hospitalization of each patient. After the specimens were inoculated into cultures of human foreskin and Vero cells, supernatants of cultures showing the cytopathic effect characteristic of HSV infection were tested for virus in a confirmatory immunoenzymatic assay. Typing of HSV was performed by polymerase chain reaction amplification of HSV-1- and HSV-2-specific DNA polymerase sequences. RESULTS: On early into the study, 12 (15%) of 82 patients had perianal ulceration and 70 did not. None of the patients in the latter group developed perianal ulcers during the study period, but HSV was isolated at least once from 17 (24%) of them. Nine of the 17 asymptomatic perianal shedders had a mean of 3 perianal swabs collected before the first HSV isolation, and 11 (65%) of 17 had a total of 18 perianal swabs collected 8 to 62 days after the HSV isolation. All postpositive samples were negative for HSV except 1 obtained from a patient 13 days after the first positive sample. Twelve of the 17 asymptomatic perianal shedders of HSV were followed up clinically for 8 to 62 days after the first episode of shedding and none developed perianal ulceration. CONCLUSIONS: We conclude that asymptomatic perianal shedding of HSV is common in patients with AIDS, even among those without a history of perianal HSV lesions. This shedding appears to be short-lived, intermittent, and not associated with early subsequent development of perianal ulcers. These findings present a new perspective on the natural course of perianal HSV infection in patients with AIDS.