Tinea Negra Simulando Melanoma

ABSTRACT Tinea nigra is characterized as a rare fungal infection on corneous layer, caused by the fungus Phaeoannellomyces werneckii. It’s noticeable the similarity between cases of black tinea and melanoma, and its differentiation is recommended to avoid invasive procedures. As a rare and even less incident disease in the state, a 33-year-old female patient is described, presenting a plantar macula between the third and fourth right pododactyls, with light brown hyphae interspersed at dermoscopy. Diagnosis confirmed with mycological exam. The diagnosis can be enhanced by using dermatoscope, whose access has evolved, but it’s confirmed by mycological exam. Key words: tinea negra; melanoma; dermatoscopy; dermatomycoses.RESUMO A tinea negra caracteriza-se como uma infecção fúngica rara à camada córnea, causada pelo fungo Phaeoannellomyces werneckii. É notória a semelhança entre casos dessa dermatofitose e do melanoma, e sua diferenciação é preconizada para evitar procedimentos invasivos. Tratando-se de uma doença rara e ainda menos incidente no estado, descreve-se uma paciente de 33 anos do sexo feminino, apresentando mácula plantar entre o terceiro e quarto pododáctilos direto, com hifas marrons claras entrecruzadas à dermatoscopia. Diagnóstico confirmado com exame micológico direto. O diagnóstico pode ser potencializado pelo uso do dermatoscópio, cujo acesso tem evoluído, mas é confirmado com exame micológico direto. Palavras chave: tinea negra; melanoma; dermatoscopia; dermatofitose

DERMATOSE CINZENTA (EDP) - UM RELATO DE CASO EM PALMAS – TO

INTRODUCTION: Ashy dermatosis is a rare dermatosis of unknown etiology and pathogenesis, more common in people with darker skin. However, in this case report, the patient is white. CASE REPORT: A 54-year-old white woman with a history of asymptomatic gray-stained macules located on the craniocaudal axis. Despite a positive antinuclear antibody (ANA) test, the use of Plaquinol was suspended due to the fact that the patient did not present rheumatologic affections. A biopsy compatible with the condition of ashy dermatosis and post-inflammation pigmentation was performed. However, the anatomopathological examination revealed superficial perivascular dermatitis with pigmented incontinence and skin fragments, a discreet superficial perivascular inflammatory mononuclear infiltrate and mild pigmentary incontinence, confirming the clinical hypothesis of ashy dermatosis. A skin lightening lotion (Arbutin 4%, Chromabright 0.5%, Alfabisabol 1%, Nicotinamide 4%, Kojico Acid 3%, Nonionic Cream) was used for 30 days with satisfactory results, along with the substitution of antihypertensive medication. FINAL CONSIDERATIONS: The report is relevant because it is necessary to know this pathology for differential diagnosis of pigmented dermatosis and so that the best treatment can be prescribed. Keywords: Ashy Dermatosis; Hyperpigmentation; Erythema Dyschromicum Perstans. RESUMO INTRODUÇÃO: A dermatose cinzenta é uma dermatose rara, de etiologia e patogenia desconhecida, mais comum em pessoas de pele mais escura, porém no caso relatado a paciente é branca. RELATO DE CASO: Mulher de 54 anos de idade, branca, com história de máculas de coloração acinzentada, assintomáticas, localizadas no eixo craniocaudal. Apesar do FAN positivo, o uso de Plaquinol foi suspenso pela paciente não apresentar afecção reumatológica. Foi realizada uma biópsia compatível com o quadro de dermatose cinzenta bem como pigmentação pós-inflamação. No entanto, no exame anatomopatológico foi encontrada dermatite perivascular superficial com incontinência pigmentar e em fragmentos de pele, um discreto infiltrado inflamatório mononuclear perivascular superficial e leve incontinência pigmentar, confirmando a hipótese clínica de dermatose cinzenta. Uma loção clareadora (Arbutin 4%, Chromabright 0,5%, Alfabisabol 1%, Nicotinamida 4%, Ácido Kojico 3%, Creme não iônico) foi utilizada por 30 dias apresentando resultados satisfatórios, além da substituição do anti-hipertensivo. CONSIDERAÇÕES FINAIS: O relato é relevante pois deve-se conhecer essa patologia para diagnose diferencial das dermatoses pigmentadas e desta forma optar pela melhor conduta terapêutica. Palavras-chave: Dermatose cinzenta; Hiperpigmentação;  Eritema Discrômico Persistente.INTRODUÇÃO: A dermatose cinzenta é uma dermatose rara, de etiologia e patogenia desconhecida, mais comum em pessoas de pele mais escura, porém no caso relatado a paciente é branca. RELATO DE CASO: Mulher de 54 anos de idade, branca, com história de máculas de coloração acinzentada, assintomáticas, localizadas no eixo craniocaudal. Apesar do FAN positivo, o uso de Plaquinol foi suspenso pela paciente não apresentar afecção reumatológica. Foi realizada uma biópsia compatível com o quadro de dermatose cinzenta bem como pigmentação pós-inflamação. No entanto, no exame anatomopatológico foi encontrada dermatite perivascular superficial com incontinência pigmentar e em fragmentos de pele, um discreto infiltrado inflamatório mononuclear perivascular superficial e leve incontinência pigmentar, confirmando a hipótese clínica de dermatose cinzenta. Uma loção clareadora (Arbutin 4%, Chromabright 0,5%, Alfabisabol 1%, Nicotinamida 4%, Ácido Kojico 3%, Creme não iônico) foi utilizada por 30 dias apresentando resultados satisfatórios, além da substituição do anti-hipertensivo. CONSIDERAÇÕES FINAIS: O relato é relevante pois deve-se conhecer essa patologia para diagnose diferencial das dermatoses pigmentadas e desta forma optar pela melhor conduta terapêutica.   Palavras-chave: Dermatose cinzenta; Hiperpigmentação;  Eritema Discrômico Persistente.&nbsp

PENFIGÓIDE BOLHOSO, DESAFIO TERAPÊUTICO EM PACIENTE COM MÚLTIPLAS COMORBIDADES

Bullous pemphigoid (BP) is an autoimmune bulge, more common in the elderly, characterized by subepidermal, tense and large blisters. This study presents an elderly patient with diabetes mellitus and systemic arterial hypertension, with diffuse blisters on the body. Laboratory examination showed eosinophilia of 742/mm3 and an increase of IgE equivalent to 469 kU/L; anatomopathological with subepidermal bubble and inflammatory infiltrate rich in eosinophils; and immunofluorescence with immunodeposits at the dermo-epidermal junction consisting of IgG and C3. Based on these findings, the patient was diagnosed with BP. Due to the comorbidities of the patient, corticotherapy was not the first option, tetracycline presented therapeutic failure, and dapsone 100mg / day for 6 months was resolution. It is concluded that each patient should have their individualized management for best results.O Pênfigóide bolhoso (PB) é uma bulose autoimune, mais comum em idosos, caracterizada por bolhas subepidérmicas, tensas e grandes. Este trabalho apresenta uma paciente idosa, portadora de Diabetes melitus e Hipertensão arterial sistêmica, com queixa de bolhas difusas pelo corpo. Ao exame laboratorial demonstrou eosinofilia de 742/mm3 e aumento de IgE equivalente a 469 kU/L; anatomopatológico com bolha subepidérmica e infiltrado inflamatório rico em eosinófilos; e imunofluorescência com imunodepósitos na junção dermo-epidérmica constituídos por IgG e C3. Mediante esses achados, paciente recebeu diagnóstico de PB. Devido as comorbidades apresentadas, a corticoterapia não foi a primeira opção, a tetraciclina apresentou falha terapêutica e a dapsona 100mg/dia, por 6 meses, foi resolutiva. Conclui-se que cada paciente deve ter seu manejo individualizado para melhores resultados. Palavras-chave: penfigóide bolhoso; bulose; doença autoimune. ABSTRACT Bullous pemphigoid (BP) is an autoimmune bulge, more common in the elderly, characterized by subepidermal, tense and large blisters. This study presents an elderly patient with diabetes mellitus and systemic arterial hypertension, with diffuse blisters on the body. Laboratory examination showed eosinophilia of 742/mm3 and an increase of IgE equivalent to 469 kU/L; anatomopathological with subepidermal bubble and inflammatory infiltrate rich in eosinophils; and immunofluorescence with immunodeposits at the dermo-epidermal junction consisting of IgG and C3. Based on these findings, the patient was diagnosed with BP. Due to the comorbidities of the patient, corticotherapy was not the first option, tetracycline presented therapeutic failure, and dapsone 100mg / day for 6 months was resolution. It is concluded that each patient should have their individualized management for best results. Keywords: Ashy pemphigoid; bulge; autoimune disease

COINFECTION BETWEEN AMERICAN TEGUMENTARY LEISHMANIOSIS AND THE HUMAN IMMUNODEFICIENCY VIRUS

Introdução: A Leishmaniose Tegumentar Americana (LTA) é uma doença infecto parasitária de acometimento cutâneo mucoso causada por protozoários do gênero Leishmania. O quadro clínico depende da espécie da Leishmania envolvida e da resposta imune do hospedeiro. Indivíduos infectados com o vírus da imunodeficiência humana (HIV) podem apresentar quadros atípicos e exuberantes de LTA. Desenvolvimento: Este trabalho relata um caso de LTA mucocutânea em um paciente HIV positivo com acometimento extenso de hemiface esquerda. Esse paciente esteve aos cuidados de uma equipe interdisciplinar e as lesões cutâneas melhoraram após uso de Anfotericina B lipossomal. Considerações Finais: O diagnóstico e tratamento precoce de casos atípico de LTA é fundamental. Mais estudos deveriam ser propostos para elucidar a imunologia da coinfecção entre HIV e LTA.Introduction: American Cutaneous Leishmaniasis (ACL) is a parasitic infectious disease of mucocutaneous impairment caused by protozoa of the genus Leishmania. Clinical features depend on the species of Leishmania involved and the immune response of the host. Human immunodeficiency virus (HIV)-infected individuals may present atypical and exuberant clinical manifestations of ACL. Development: This study reports a case of mucocutaneous ACL in a HIV-positive patient with extensive involvement of left hemiface. This pacient was in the care of an interdisciplinary team and skin lesions improved after liposomal amphotericin B. Final considerations: Early diagnosis and adequate treatment of atypical ACL is crucial. More studies should be proposed to better understand the immunology of coinfection between HIV and ACL

Ixodíase revelado pelo exame dermatoscópico: Relato de Caso

A ixodíase é uma zoodermatose causada pela picada de ixodídeos. Dos ixodídeos existentes no Brasil, o gênero mais frequente é o Amblyomma, com várias espécies, sendo a mais encontrada a A.cajennense. Relatamos o caso de um paciente que, após 2 dias que retornou da fazenda, iniciou com intenso prurido, aparecimento de inúmeras pápulas eritematosas purpúricas com crosticulas, sendo visualizado à dermatoscopia o carrapato

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially