RESUMO
The following discussion deals with three emerging infection diseases that any dermatopathologist working in the northern hemisphere can come across. The first subject to be dealt with is gnathostomiasis. This parasitic disease is produced by the third larvarial stage of the parasite that in most patients is associated with the ingestion of raw fish. Epidemiologically, it is most commonly seen in South East Asia, Japan, China, and the American continent, mainly in Mexico, Ecuador, and Peru. Nowadays, the disease is also seen in travelers living in the developed countries who recently came back from visiting endemic countries. The disease produces a pattern of migratory panniculitis or dermatitis with infiltration of eosinophils in tissue. The requirements for making the diagnosis are provided, including clinical forms, common histological findings on skin biopsy as well as the use of ancillary testing. Buruli ulcer, a prevalent mycobacterial infection in Africa, is described from the clinical and histopathological point of view. The disease has been described occasionally in Central and South America as well as in developed countries such as Australia and Japan; Buruli ulcer has also been described in travelers returning from endemic areas. Clinically, the disease is characterized by large, painless ulcerations with undermined borders. Systemic symptoms are usually absent. Classical histological findings include a particular type of fat necrosis and the presence of abundant acid fast bacilli in tissue. Such findings should raise the possibility of this disease, with the purpose of early therapeutically intervention. Lastly, the infection by free living ameba Balamuthia mandrillaris, an emerging condition seen in the US and Peru, is extensively discussed. Special attention is given to clinical and histological characteristics, as well as to the clues for early diagnosis and the tools available for confirmation.
Assuntos
Amebíase/patologia , Úlcera de Buruli/patologia , Doenças Transmissíveis Emergentes/patologia , Gnatostomíase/patologia , Dermatopatias/patologia , Pele/patologia , Amebíase/epidemiologia , Amebíase/parasitologia , Balamuthia mandrillaris/patogenicidade , Biópsia , Úlcera de Buruli/epidemiologia , Úlcera de Buruli/microbiologia , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/microbiologia , Doenças Transmissíveis Emergentes/parasitologia , Diagnóstico Diferencial , Gnatostomíase/epidemiologia , Gnatostomíase/parasitologia , Interações Hospedeiro-Parasita , Humanos , Valor Preditivo dos Testes , Pele/microbiologia , Pele/parasitologia , Dermatopatias/epidemiologia , Dermatopatias/microbiologia , Dermatopatias/parasitologiaRESUMO
La gnatostomiasis es una zoonosis parasitaria causada por algunas especies del género de helmintos Gnathostoma . La presentación clínica es muy variada y su diagnóstico constituye un desafío; es endémica en países tropicales y subtropicales, y la transmisión se asocia con el consumo de carne de animales acuáticos, cruda o mal cocida. En las últimas décadas, el creciente turismo internacional y el consumo de alimentos exóticos, han provocado un notable aumento de casos de la enfermedad. En nuestro país no se ha reportado ningún caso confirmado de gnatostomiasis. Se presenta el caso de un hombre colombiano de 63 años de edad, viajero frecuente al exterior, que consultó por presentar síntomas gastrointestinales. Durante la hospitalización desarrolló una lesión cutánea en el flanco abdominal derecho, de la cual se extrajo una larva cuya descripción morfológica permitió clasificarla como Gnathostoma spinigerum . Se trata de la primera confirmación de un caso importado de gnatostomiasis en Colombia. En este artículo se discuten las generalidades, la etiología, la patogenia y el tratamiento de la enfermedad, con especial énfasis en las características particulares de este paciente.
Gnathostomiasis is a parasitic zoonosis caused by some species of helminthes belonging to the genus Gnathostoma . It has a wide clinical presentation and its diagnosis is a challenge. Tropical and subtropical countries are endemic, and its transmission is associated with eating raw or undercooked meat from fresh water animals. Increasing global tourism and consuming exotic foods have produced a noticeable rise in cases of the disease in the last decades. However, in our country, there has not been any confirmed case of gnathostomiasis previously reported. We present the case of a 63-year-old Colombian man with an international travel history, who presented with gastrointestinal symptoms. During the hospital stay, he developed a cutaneous lesion on the upper right abdominal quadrant, where later, a larva was found. A morphological study allowed us to identify it as Gnathostoma spinigerum . As such, this is the first report of an imported case of gnathostomiasis confirmed in Colombia. This article describes the principles, etiology, pathogenic cycle and treatment of this disease with special considerations to our patient´s particular features.
Assuntos
Animais , Humanos , Masculino , Pessoa de Meia-Idade , Larva Migrans/diagnóstico , Gnatostomíase/diagnóstico , Gnathostoma/isolamento & purificação , Viagem , Larva Migrans/parasitologia , Parasitologia de Alimentos , Alimentos Marinhos/parasitologia , Colômbia/epidemiologia , Abdome , Gnatostomíase/transmissão , Gnatostomíase/epidemiologia , Gnathostoma/crescimento & desenvolvimento , Larva , Estágios do Ciclo de VidaRESUMO
Gnathostomiasis is a parasitic zoonosis caused by some species of helminthes belonging to the genus Gnathostoma . It has a wide clinical presentation and its diagnosis is a challenge. Tropical and subtropical countries are endemic, and its transmission is associated with eating raw or undercooked meat from fresh water animals. Increasing global tourism and consuming exotic foods have produced a noticeable rise in cases of the disease in the last decades. However, in our country, there has not been any confirmed case of gnathostomiasis previously reported. We present the case of a 63-year-old Colombian man with an international travel history, who presented with gastrointestinal symptoms. During the hospital stay, he developed a cutaneous lesion on the upper right abdominal quadrant, where later, a larva was found. A morphological study allowed us to identify it as Gnathostoma spinigerum . As such, this is the first report of an imported case of gnathostomiasis confirmed in Colombia. This article describes the principles, etiology, pathogenic cycle and treatment of this disease with special considerations to our patient´s particular features.
Assuntos
Gnathostoma/isolamento & purificação , Gnatostomíase/diagnóstico , Larva Migrans/diagnóstico , Abdome , Animais , Colômbia/epidemiologia , Parasitologia de Alimentos , Gnathostoma/crescimento & desenvolvimento , Gnatostomíase/epidemiologia , Gnatostomíase/transmissão , Humanos , Larva , Larva Migrans/parasitologia , Estágios do Ciclo de Vida , Masculino , Pessoa de Meia-Idade , Alimentos Marinhos/parasitologia , ViagemRESUMO
Seasonality of the nematode Gnathostoma turgidum in Virginia opossums (Didelphis virginiana) in the wild has been reported; however, the mechanisms involved in deworming are unknown. We monitored the parasitologic and biologic changes in four Virginia opossums naturally infected with G. turgidum by coproparasitologic examination and abdominal ultrasonography. Eggs became detectable in the feces of opossums in May, peaked in July and August, and suddenly decreased in October. Adults of G. turgidum were expelled in the feces mainly in September. Ultrasonography of the liver showed slight damage during May. Lesions in the stomach appeared in April and persisted until September. The abnormalities of the liver and stomach were resolved in November. These data suggest that G. turgidum is likely expelled as a result of host immunologic mechanisms, although termination of a natural life span cannot be definitively excluded.
Assuntos
Didelphis/parasitologia , Gnathostoma/fisiologia , Gnatostomíase/veterinária , Animais , Fezes/parasitologia , Feminino , Gnatostomíase/epidemiologia , Gnatostomíase/imunologia , Gnatostomíase/parasitologia , Masculino , México/epidemiologia , Estações do AnoRESUMO
Objetivo: determinar las características epidemiológicas y clínicas de la gnatostomiasis en un consultorio de práctica privada de Lima. Material y métodos: estudio descriptivo de una serie de pacientes con diagnóstico de gnatostomiasis en un consultorio privado de dermatología en Lima. Se revisaron las historias de los pacientes diagnosticados de gnatostomiasis según criterio clínico e histopatológico entre enero del 2010 y setiembre del 2011; además se realizó una encuesta telefónica para obtener los antecedentes epidemiológicos. Resultados: se identificaron 20 pacientes de los cuales 18 tuvieron los datos clínicos completos. La población en estudio estuvo conformada por 18 pacientes con diagnóstico de gnatostomiasis. Todos residían en distritos de estrato social alto. La edad promedio fue de 47.5 años. La forma de presentación clínica más frecuente fue la infamatoria o paniculítica y la localización topográfica más frecuente fue en tórax. Se evidenció eosinofilia en trece pacientes. Cinco pacientes recibieron albendazol 400mg/d por 21 días y trece pacientes recibieron tratamiento combinado de albendazol 400-800mg/d por 21 días con ivermectina 200ug/kg/dosis en una o dos oportunidades. La mayor frecuencia de consumo de pescado crudo fue de una a dos veces por semana. El tipo de comida más consumida fue el cebiche. El tipo de pescado más frecuente de consumo fue la corvina en restaurantes exclusivos de precios altos. Conclusión: el número de casos de gnatostomiasis vistos en el presente reporte fue mayor en el periodo del 2011 comparado con el 2010. La forma de presentación clínica más frecuente fue la infamatoria o profunda. El pescado crudo más frecuente consumido por estos pacientes fue el de corvina en forma de cebiche en restaurantes en el rango de alto precio. Todos los pacientes tuvieron buena respuesta terapéutica con los antiparasitarios, siendo la combinación de albendazol e ivermectina la más utilizada.
Aim: to determine the epidemiological and clinical characteristics of gnathostomiasis in a private practice setting in Lima, Peru. Methods: descriptive study of a group of patients with gnathostomiasis attended at a dermatology private clinic at Lima. We reviewed the records of all patients with diagnosis of gnathostomiasis, based on clinical and histopathological findings, from January 2010 to September 2011; we also conducted a telephone interview to obtain additional epidemiological data. Results: we identified 20 cases of which 18 had a complete clinical history. All subjects reported residing in a higher social strata neighborhood. The average age was 47.2 years. The most common clinical presentation was the deep paniculitic form and chest was the most common topographic location. Eosinophilia was present in 13 patients. Five patients received albendazole 400 mg / d for 21 days and thirteen patients were treated with combination of albendazole 400-800mg/d for 21 days and ivermectin 200ug/kg/dosis in one or two occasions. The highest frequency of raw fish consumption before the disease was once to twice a week. Regarding the type of food, most patients consumed cebiche. The most common type of consumed fish was seabass in exclusive restaurants of high prices. Conclusion: the number of gnathostomiasis cases seen in this report was higher in the period of 2011 compared with 2010. The most common clinical presentation was the inflamatory or paniculitic form. Seabass cebiche was the most common type of raw fish consumed by patients, always in expensive restaurants. All patients had good therapeutic response to antiparasitics, with the combination of albendazole and ivermectin as the most used therapeutic regimen.