Osteoarticular Sporotrichosis of the Knee Caused by Sporothrix brasiliensis: Two Similar Cases with Different Outcomes.

Sporotrichosis is the most frequent subcutaneous or implantation mycosis in Latin America, and its transmission occurs as a result of traumatic inoculation into the skin by organic matter containing the thermodimorphic fungi of the genus Sporothrix. Although cutaneous forms are more common, another important site is the osteoarticular system, whose hematogenous involvement is commonly associated with disseminated forms, especially in people who have an immunosuppressive condition, such as HIV/AIDS, chronic steroid use, and alcohol abuse. We present two cases of osteoarticular sporotrichosis of the knee caused by Sporothrix brasiliensis and followed up at our institution, with different outcomes. In the cases presented here, aging, anatomical sites, comorbidities, subtherapeutic serum levels, low adherence to treatment, and late diagnosis for different reasons may explain the observed outcomes. Early diagnosis of Sporothrix infection is critical in preventing complications, including death. We also highlight the importance of multidisciplinary follow-up and adherence to treatment for a favorable outcome.

Pulmonary Sporotrichosis Caused by Sporothrix brasiliensis: A 22-Year, Single-Center, Retrospective Cohort Study.

Pulmonary sporotrichosis is a rare condition. It can present as a primary pulmonary disease, resulting from direct Sporothrix species (spp). conidia inhalation, or as part of multifocal sporotrichosis with multiple organ involvement, mainly in immunocompromised patients. This study aimed to describe the sociodemographic and epidemiological characteristics and clinical course of patients with positive cultures for Sporothrix spp. from pulmonary specimens (sputum and/or bronchoalveolar lavage) at a reference center in an area hyperendemic for zoonotic sporotrichosis. The clinical records of these patients were reviewed. Fourteen patients were included, and Sporothrix brasiliensis was identified in all cases. Disseminated sporotrichosis was the clinical presentation in 92.9% of cases, and primary pulmonary sporotrichosis accounted for 7.1%. Comorbidities included human immunodeficiency virus infection (78.6%), alcoholism (71.4%), and chronic obstructive pulmonary disease (14.3%). Treatment with amphotericin B followed by itraconazole was the preferred regimen and was prescribed in 92.9% of cases. Sporotrichosis-related death occurred in 42.9% while 35.7% of patients were cured. In five cases there was a probable contamination from upper airway lesions. Despite the significant increase in sporotrichosis cases, pulmonary sporotrichosis remains rare. The treatment of disseminated sporotrichosis is typically difficult. Prompt diagnosis and identification of all affected organs are crucial for better prognosis.

Avaliação radiológica das vasculites pulmonares / Radiological evaluation of pulmonary vasculitis

A vasculite pulmonar corresponde a um grupo heterogêneo de doenças e de diagnóstico difícil. Esta revisão aborda o papel da radiologia na avaliação dessas entidades. Os achados de imagem são variados e pouco específicos na vasculite pulmonar, mas uma análise padronizada das alterações radiológicas pode ajudar a estreitar o diagnóstico diferencial. Neste artigo, uma análise radiológica baseada no tamanho dos vasos acometidos é utilizada para classificar as vasculites primárias. A hemorragia alveolar difusa é uma das manifestações das vasculites pulmonares primárias, além de várias doenças, e também é revisada neste artigo. A integração das características clínicas, laboratoriais e radiológicas é importante para uma diagnóstico mais específico de várias formas de vasculite pulmonar

The pulmonary vasculitides encompass a heterogenous group of diseases and are usually hard to diagnose. This review addresses the role of imaging in the investigation of pulmonary vasculitis. Imaging are variable and poorly specific in pulmonary vasculitis, but a pattern approach based on radiologic findings may help to refine or narrow the diferential diagnosis. In this article, an approach based on the size of the affected vessels in used to classify the primary vasculitides. Diffuse alveolar hemorrhage is one of the manifestations of primary pulmonary vasculitis, among other entities, and is also revisited in this review. Integration of clinical, laboratory, and imaging findings is important for making a specific diagnosis of pulmonary vasculitis

[Percutaneous vertebroplasty for vertebral osteoporotic fractures: long term analysis]. / Vertebroplastia percutânea nas fraturas vertebrais por osteoporose: avaliação a longo prazo.

OBJECTIVE: To assess the long-term efficacy of percutaneous vertebroplasty for the treatment of pain resulting from osteoporotic vertebral fractures. METHOD: 26 percutaneous vertebroplasty procedures were performed for osteoporotic vertebral fractures in 15 patients during the period between July 2001 and May 2004. Before and after the procedure, a 10-point scale of pain was obtained. These scale was repeated at long-term follow up in two different moments after the procedure with one year interval. During these moments, the satisfaction, ambulation and ability to perform activities of daily living (five-point scale) were also analyzed. RESULTS: The majority of patients (n=13) presented the 10-point pain scale between 8 and 10 before the percutaneous vertebroplasty. After the procedure, there was important improve of the pain, and nine patients presented zero point-scale and three patients between 1 and 4 (p<0.001). At long-term follow up with one year interval, there was no significant difference between the pain scale, the ambulation and the ability to perform activities of daily living. Fourteen patients reported a future willingness to undergo the procedure for treatment in case of a new compression fracture. CONCLUSION: Percutaneous vertebroplasty can be a useful procedure for the treatment of pain and disability after secondary osteoporotic vertebral fractures with durable results in selected patients.

Vertebroplastia percutânea nas fraturas vertebrais por osteoporose: avaliação a longo prazo / Percutaneous vertebroplasty for vertebral osteoporotic fractures: long term analysis

OBJETIVO: Avaliar a resposta terapêutica a longo prazo da vertebroplastia percutânea para o tratamento da dor decorrente de fraturas de corpo vertebral por osteoporose. MÉTODO: Foram realizadas 26 vertebroplastias percutâneas em 15 pacientes com dor por fraturas osteoporóticas de corpo vertebral, durante o período de julho de 2001 a maio de 2004. Imediatamente antes e após o procedimento, foi aferido o grau de dor de cada paciente com base em uma escala verbal álgica entre zero e dez. Esta aferição foi repetida a longo prazo, com um ano de intervalo, sendo ainda investigada a satisfação do paciente, a deambulação e as atividades diárias (escalas de cinco pontos). RESULTADOS: Observou-se que a maioria dos pacientes (n=13) apresentava escala verbal de dor entre 8 e 10 antes da vertebroplastia. Houve importante redução álgica no dia seguinte, com 9 pacientes apresentando ausência de dor e três pacientes escala álgica entre 1 e 4 (p<0,001). No acompanhamento a longo prazo, com um ano de intervalo, a melhora dos sintomas se manteve, sem diferença significativa na escala de dor, na deambulação e nas atividades diárias. Quando questionados se fariam novamente este tratamento no caso de nova fratura vertebral, 14 pacientes responderam que sim. CONCLUSÃO: A vertebroplastia percutânea pode ocasionar importante melhora da dor em pacientes com fraturas osteoporóticas de corpo vertebral, quando bem selecionados, com boa resposta a longo prazo.

OBJECTIVE: To assess the long-term efficacy of percutaneous vertebroplasty for the treatment of pain resulting from osteoporotic vertebral fractures. METHOD: 26 percutaneous vertebroplasty procedures were performed for osteoporotic vertebral fractures in 15 patients during the period between July 2001 and May 2004. Before and after the procedure, a 10-point scale of pain was obtained. These scale was repeated at long-term follow up in two different moments after the procedure with one year interval. During these moments, the satisfaction, ambulation and ability to perform activities of daily living (five-point scale) were also analyzed. RESULTS: The majority of patients (n=13) presented the 10-point pain scale between 8 and 10 before the percutaneous vertebroplasty. After the procedure, there was important improve of the pain, and nine patients presented zero point-scale and three patients between 1 and 4 (p<0.001). At long-term follow up with one year interval, there was no significant difference between the pain scale, the ambulation and the ability to perform activities of daily living. Fourteen patients reported a future willingness to undergo the procedure for treatment in case of a new compression fracture. CONCLUSION: Percutaneous vertebroplasty can be a useful procedure for the treatment of pain and disability after secondary osteoporotic vertebral fractures with durable results in selected patients.