Familial occurrence of zoonotic sporotrichosis

A esporotricose é micose subaguda ou crônica, causada pelo fungo dimórfico Sporothrix schenckii, endêmica no Brasil e transmitida principalmente através da inoculação traumática de seu agente causal na pele. A transmissão zoonótica, especialmente por gatos infectados, tem sido demonstrada em diversos relatos e séries de casos. Nós descrevemos a ocorrência simultânea da doença em três membros de uma mesma família através da arranhadura por gato doméstico infectado. Dois pacientes desenvolveram a forma cutânea-linfática e apenas um desenvolveu a forma cutânea fixa. Dois pacientes foram tratados com sucesso, com solução saturada de iodeto de potássio; entretanto, o terceiro caso apresentou efeitos colaterais e teve seu tratamento substituído por itraconazol, com resolução de suas lesõesSporotrichosis is a subacute or chronic mycosis caused by the dimorphic fungus Sporothrix schenckii which is endemic in Brazil and is transmitted primarily through traumatic inoculation of its causative agent into the skin. The zoonotic transmission, especially from infected cats, has been demonstrated in several reports and case series. We present simultaneous occurrence of the disease in three members of the same family by scratches from an infected domestic cat. Two patients developed the lymphocutaneous form and one only developed the fixed cutaneous form. Two patients were successfully treated with saturated solution of potassium iodide; however, the third case reported side effects and had his therapy substituted for itraconazole, with resolution of his lesion

PD-L1 may mediate T-cell exhaustion in a case of early diffuse Leishmaniasis caused by Leishmania (L.) amazonensis

Introduction: Diffuse cutaneous leishmaniasis (DCL) is a rare disease form associated with Leishmania (L.) amazonensis in South America. It represents the “anergic” pole of American Tegumentary Leishmaniasis, and the explanation for its resistance to treatment remains elusive. We aimed to study some possible immunological mechanisms involved in the poor DCL treatment response by evaluating some cell surface molecules obtained from a patient with DCL by flow cytometry. Case presentation: A 65-year-old DCL patient who initially failed to respond to the standard treatment for the disease showed vacuolated macrophages filled with amastigotes in lesion biopsy, and L. (L.) amazonensis was identified through ITS1PCR amplification. The Leishmania skin test and indirect immunofluorescence analysis revealed negative results. Peripheral blood from the patient was collected after a few months of treatment, when the patient presented with no lesion. Peripheral blood mononuclear cells were analyzed ex vivo and in vitro after 48 h of stimulation with soluble L. (L.) amazonensis antigen (SLA). Cell death, surface molecules, and intracellular molecules, such as IFN-γ and granzyme B, were analyzed in the cells using flow cytometry. Analysis of the surface markers showed an increased expression of the inhibitory molecule programmed death ligand 1 (PD-L1) in the monocytes restimulated with SLA (approximately 65%), whereas the negative controls were 35% positive for PD-L1. Conversely, compared with the negative controls, we observed a decrease in CD4+IFN-γ+ T cells (8.32 versus 1.7%) and CD8+IFN-γ+ T cells (14% versus 1%). We also observed a relevant decrease in the granzyme B levels in the CD8+ T cells, from 31% in the negative controls to 5% after SLA restimulation. Conclusion: The dysfunctional activation of PD-L1 inhibitory pathway after Leishmania antigen stimulation and reduced levels of IFN-gamma and granzyme B-producing cells could be closely related to unresponssiveness to standard drug treatment of DCL patient

Tratamento da Leishmaniose Tegumentar Americana Treatment of american cutaneous leishmaniasis

A leishmaniose tegumentar americana é doença infecciosa da pele e mucosa, cujo agente etiológico é um protozoário do gênero Leishmania. Seu tratamento é desafio porque as drogas disponíveis apresentam elevada toxicidade, e nenhuma delas é bastante eficaz. A recidiva, a falha terapêutica em pacientes imunodeprimidos e a resistência ao tratamento são fatores que motivam a busca de uma droga ideal.American cutaneous leishmaniasis is an infectious disease of the skin and mucosa caused by a protozoon of the genus Leishmania. Its treatment is a challenge since the drugs available are highly toxic and none is completely effective. Recurrence, therapeutic failure in immunosuppressed patients and treatment resistance are some factors that encourage searching an ideal drug

Wade’s histoid leprosy in a 14-year-old teenage boy

Abstract Wade’s histoid leprosy (HL) is a rare variant of multibacillary leprosy, with characteristic clinical, immunologic, histopathologic, and bacteriologic features. It is associated with resistance to sulfa drugs or polychemotherapy and is rarely observed in patients who have not undergone prior treatment. Clinically, HL resembles keloid or dermatofibroma. Furthermore, HL is rare in children and is difficult to diagnose even by experts. This report describes a case of HL in a 14-year-old Brazilian boy, who presented with multiple nodular and tumor-like lesions, simulating keloids. He had not undergone prior treatment with anti-leprosy drugs, which accentuates the relevance of this case report

Leishmaniose mucosa fatal em criança

A leishmaniose tegumentar americana, doença endêmica e crescente no Brasil, pode manifestar-se por úlceras na pele e lesões nas mucosas nasal, oral e faringiana. O antimônio pentavalente é a droga de primeira escolha no tratamento, com resposta menos favorável nas formas mucosas. Destaca-se a dificuldade para diagnosticar e tratar um caso de leishmaniose mucosa em criança de cinco anos que teve exames parasitológicos, imunológicos e reação em cadeia da polimerase negativos. Somente após várias repetições o esfregaço foi positivo. A paciente apresentou infecção bacteriana secundária persistente das lesões e falta de resposta a drogas específicas e antibióticos, evoluindo para septicemia e óbito

A randomized, open-label clinical trial comparing the long-term effects of miltefosine and meglumine antimoniate for mucosal leishmaniasis

Abstract INTRODUCTION: The treatment of mucosal leishmaniasis (ML) is difficult due to the toxicity and route of administration of standard drugs. Miltefosine is an oral agent used for leishmaniasis treatment; however, no data exist regarding its use for ML in Brazil. In this study, we aimed to evaluate the efficacy of miltefosine for ML treatment compared to that of pentavalent antimonial in a pilot study. METHODS: We performed a randomized clinical trial with two parallel groups. The tested intervention consisted of miltefosine 1.3-2 mg/kg/day (two capsules) for 28 days or intravenous 20 mg SbV/kg/day of meglumine antimoniate (N-MA) for 30 days. The final endpoint was defined as complete healing of the lesion four years after treatment. We also analyzed an early endpoint at 90 days after treatment. RESULTS: Forty patients were included in this study: each experimental group comprised 20 patients. Applying a multivariate model in an intention-to-treat analysis, we observed that patients treated with miltefosine had a cure probability 2.08 times greater (95% confidence interval [CI] = 1.03-4.18) than those treated with N-MA at 90 days after treatment. At the final endpoint, we observed no differences in cure probability between miltefosine and N-MA (relative risk = 0.66; 95% CI = 0.33-1.32). With respect to adverse reactions, significant differences between groups were related to gastrointestinal effects, which were more frequent in the miltefosine group. CONCLUSIONS: Miltefosine may be an interesting alternative for treating ML because of its oral administration and cure rate after long-term follow-up