Kikuchi´s disease of the xanthomathous type with cutaneous manifestation

Kikuchi's disease is a benign, self-limiting disease, whose pathogenesis remains unknown. Patients most often present with cervical lymphadenopathy, sometimes associated with fever and leukopenia. It has been reported that up to 40% of patients with Kikuchi's disease have also cutaneous eruptions, but no specific skin changes have been described. Kikuchi's disease can be subclassified into three histologic subtypes: a proliferative type, a necrotizing type and a xantomathous type. Most patients with Kikuchi's disease require no specific treatment, because the disease regresses spontaneously, within a few weeks to months. We report a case of a 31-year-old woman with xanthomatous type of Kikuchi's disease, whose first manifestation was the onset of erythematous papules with central suppuration on her face and on her left hand

Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique

Introduction: Leptospirosis is a neglected zoonotic disease caused by a bacteria of the genus Leptospira. In Africa, it is frequently mistaken for frequently occurring conditions such as malaria. The aim of this study was to identify rodent species involved in the transmission of the disease, the prevalence of pathogenic Leptospira spp. in selected rodent species and risk factors for human leptospirosis. Material and Methods: We conducted a descriptive and exploratory epidemiological and molecular study in Mozambique Island city in 2015. Six neighborhoods, comprising 30 households each were randomly selected. People from the selected 180 households were interviewed regarding their awareness of the disease, the presence of rodents in their houses, chemicals used to eliminate them, sewage disposal, water supply system, and other key issues related to the disease. In each neighborhood, we trapped 10 rodents for a morphometric study to identify their species and for molecular isolation of Leptospira DNA. We extracted kidneys from 57/60 of rodents trapped and performed nested polymerase chain reaction targeting rrs 16S ribosomal RNA and lipL32 genes for identification of Leptospira genus and pathogenic Leptospira spp. respectively. Results: Of the 180 participants 92 (51%) reported having heard of leptospirosis;107 (59%) have had the disease; 151 (83%) reported the existence of rats in their house; 100 (56%) had latrines; 118 (66%) used chemicals to kill the rats; 102 (57%) used well water and 114 (63%) used trash containers. The most prevalent rodent species captured was Rattus norvegicus 36/60 (60%), followed by Rattus rattus 19/60 (31.67%) and Mus musculus 3/60 (5%). Sequences of rrs 16S rRNA gene were identified rrs 16S ribosomal DNA RNA was identified in 20/57 (35.%) rodents. Out these two were positive for lipL32 gene, giving an overall pathogenic Leptospira infection of 3.5% (2/57). The rodent species identified as carriers of pathogenic Leptospira were Rattus norvegicus (1) and R. rattus (1). Conclusion: This is the first study in Mozambique to identify the presence of pathogenic species of Leptospira using molecular tools. Leptospirosis risk factors in Mozambique Island city are rodent’s infestation, limited disease awareness, lack of access to clean water, insufficient resources for waste collection, greater clustering of households, poor sanitation environment and degradation of living conditions. Pathogenic Leptospira spp. are present in the area studied and at least two species of rodents, the R. rattus and R. norvegicus are potentially involved in the transmission of the causal agents of the disease.publishersversionpublishe

Feohifomicosis Producida por Alternaria Infectoria con Presentación Clínica de Múltiples Lesiones Vegetantes en un Paciente Sometido a un Trasplante Renal

The genus Alternaria is one of the most common black moulds and appears to be increasing as a causative agent of subcutaneous phaeohyphomycosis, particularly among immunosuppressed patients. A 53-year-old patient who had received a kidney transplant presented with multiple verrucous lesions on the distal extremities. Positive histopathology and cultures, in addition to rDNA ITS region sequencing, identified the fungal isolate as Alternaria infectoria. Oral itraconazole was administered for 10 months. A follow-up at 15 months demonstrated no signs of infection. Clinical manifestations of cutaneous alternariosis vary significantly and only a few cases have been described in the literature. Although optimal treatment options remain controversial, this case of phaeohyphomycosis was successfully treated with itraconazole monotherapy

Pitiríase Rubra Pilar em Doente de Raça Negra

info:eu-repo/semantics/publishedVersio

Intravenous immunoglobulin in dermatology – clinical experience in Hospital de Braga

Introdução: Nos últimos anos tem aumentado a experiência clínica com o uso de Imunoglobulinas Endovenosas (IgEv) em Dermatologia. Apesar da informação limitada na literatura, a utilização off-label das IgEv tem demonstrado eficácia na terapêutica de várias dermatoses refratárias aos tratamentos convencionais. Material e métodos: Efetuou-se um estudo retrospetivo dos doentes com patologia dermatológica tratados com IgEv entre Janeiro de 2004 e Outubro de 2011 no Serviço de Dermatologia do Hospital de Braga. Foram analisadas as características demográficas e clínicas, as terapêuticas efetuadas, a resposta clínica e o perfil de segurança. Resultados: Foram tratados 21 doentes com IgEv em 10 diferentes patologias dermatológicas: quatro doentes com Pênfigo Vulgar [2 com resposta completa (RC), um com resposta parcial (RP) e outro que interrompeu o tratamento por efeito lateral grave]; dois doentes com Penfigóide Bolhoso (um com RC e outro com RP); três doentes com Necrólise Epidérmica Tóxica (NET) com RC; dois doentes com Dermatomiosite (ambos com RP); quatro doentes com Urticária Crónica (um com RC, um com RP, um que não respondeu e outro que suspendeu o tratamento por efeito lateral); dois doentes com Vasculopatia Livedóide com RP; um doente com Síndrome CREST que não melhorou; um doente com Escleromixedema com RP; um doente com Pioderma Gangrenoso com RC e uma doente com Dermite Atópica que interrompeu o tratamento na sequência de gravidez. Com excepção dos 3 doentes com NET, em todos os outros a doença havia sido refratária aos tratamentos sistémicos convencionais. Conclusões: Apesar de a nossa experiência ser limitada, o tratamento com IgEv pode ser benéfico em determinadas patologias que não melhoram com o tratamento clássico. Atendendo ao seu custo elevado e efeito terapêutico variável, o seu uso deve ser criterioso até que mais estudos definam a relação risco-benefício

Accuracy of the new rapid test for monitoring adalimumab levels

The loss of response to adalimumab (ADL) has been related to low serum concentrations at trough. Currently, most methods commercially available for the quantification of ADL are enzyme-linked immunosorbent assay (ELISA) based, with a turnaround time of approximately 8 h, delaying the target dosage adjustment to the subsequent infusion. In this study, we aimed to evaluate the performance of the newly available rapid-test ADL quantification assay by comparing it with three established ELISA methods, using spiked samples and a set of clinical samples.info:eu-repo/semantics/publishedVersio

que apoio ao diagnóstico de Borreliose de Lyme?

No diagnóstico de borreliose de Lyme, infecção sub-diagnosticada em Portugal, o apoio laboratorial é crucial para o tratamento atempado dos doentes, sob risco destes evoluírem para fases crónicas, resistentes à terapêutica. A difícil confirmação do agente etiológico através da cultura, aliada ao conhecimento actual sobre as elevadas taxas de falsos negativos nos testes serológicos de rastreio, bem como de casos seronegativos de doença, torna da maior importância a implementação da nova tecnologia de amplificação (PCR) de DNA borreliano no diagnóstico de rotina desta patologia. Tratando-se de uma técnica mais rápida e sensível tem-se revelado de maior sucesso do que a cultura. O presente trabalho compara a sensibilidade destas duas técnicas de detecção directa dos agentes do complexo Borrelia burgdorferi sensu lato, em 96 doentes com suspeita clínica desta afecção e em 569 vectores (ixodídeos) capturados em território nacional. Obteve-se o isolamento de borrélias em 1,3% das biópsias cutâneas e em 1,2% dos ixodídeos (carraças) não se tendo registado isolados noutros materiais biológicos humanos. A aplicação da técnica de nested PCR confirmou a presença de DNA de B. burgdorferi sensu lato em 24,8% das amostras analisadas. A identificação dos agentes patogénicos, por técnicas de hibridação (Reverse Line Blot), sequenciação e/ou RFLP, revelou a presença de quatro espécies genómicas: B. garinii, B. lusitaniae, B. valaisiana e B. afzelii. Em conclusão, a amplificação de DNA borreliano permite uma resposta mais rápida e sensível do que a cultura, contribuindo para um diagnóstico laboratorial mais eficaz da borreliose de Lyme humana. Lyme borreliosis (LB) is an under-diagnosed zoonosis in Portugal, specially due to the absence of specific clinical signs. The role of the laboratory diagnosis, together with an epidemiological information, is extremely important for the correct treatment of patients with this pathology. The sensitivity of two laboratory techniques (culture and DNA amplification by nested PCR) for direct detection of Borrelia burgdorferi sensu lato complex agents was evaluated in samples from 96 clinically suspected patients, as also in 569 vector ticks collected throughout Portugal. Borrelia genospecies were identified in 1.3% of the skin biopsies and in 1.2% of the vectors, after growth in selective culture medium (BSK). No growth was obtained from other type of samples. B.burgdorferi sensu lato DNA was present in 24.8% of analyzed samples, as per intergenic rRNA 5S-23S (rrf–rrl) spacer amplification by nested PCR. Four genomic species (B.garinii, B.lusitaniae, B.valaisiana and B.afzelii) were identified by DNA hybridization (Reverse-Line-Blot), sequencing and/or RFLP. In conclusion and taking into account the results found in this study, it seems that Borrelia DNA amplification technique is quicker and present higher sensitivity than culture, providing a more effective laboratory diagnosis of LB in human populations and in vectors.publishe