Dermatophytosis and immunovirological status of HIV-infected and AIDS patients from Sao Paulo city, Brazil.

Over the past decades, more people became infected with human immunodeficiency virus (HIV) and developed acquired immunodeficiency syndrome (AIDS). Because of that the incidence of fungal infections rose dramatically. It happened because this virus can modify the course of fungal diseases, leading to altered clinical pictures. The aim of this study was to evaluate epidemiological and biological aspects of dermatophytosis in HIV-positive and AIDS patients living in the city of São Paulo, Brazil. A total of 84 (44 HIV-positive and 40 AIDS) patients were enrolled in this study. The patients were tested for dermatophyte infections, as well as for the CD4(+) /CD8(+) and HIV viral load counts. Tinea unguium was most frequently observed in AIDS patients, whereas Tinea pedis was mostly observed in HIV-positive patients. The most frequent dermatophyte species was Trichophyton rubrum. CD4(+) counts and CD4(+) /CD8(+) ratios were not associated with a higher risk for dermatophytosis. On the other hand, viral load higher than 100 000 copies/ml was associated with a higher frequency of dermatophytosis. The results suggest to that although dermatophytosis is common in HIV-positive and AIDS patients, the degree of immunosuppression does not seems to correlate with increased risk of this fungal infection. In addition, high viral load as a predictive risk factor for dermatophyte infection should be subject of further evaluations.

Leukocytoclastic vasculitis: another condition that mimics syphilis.

Syphilis, a disease that in the past was associated with significant morbidity and lethality rates, has resurged in recent years principally as a consequence of changes in risk behavior. An epidemiological group that is commonly affected is the HIV-infected population. The characteristics of the disease and its progression may differ in these patients. The present report describes a case of an HIV-positive male patient, who developed florid secondary syphilis: in addition to syphilitic roseola, he also presented with bilateral panuveitis and involvement of the central nervous system. Investigation revealed the prozone phenomenon and histological examination of the skin lesions showed the presence of leukocytoclastic vasculitis. This finding is extremely rare and few cases have been documented.

Vasculite leucocitoclástica: mais uma "imitação" da sífilis / Leukocytoclastic vasculitis: another condition that mimics syphilis

A sífilis, doença de importante morbiletalidade no passado, tem ressurgido nos últimos anos, graças, sobretudo, às alterações nos comportamentos de risco. Um grupo epidemiológico, frequentemente, acometido é a população com infecção pelo HIV: estes pacientes podem apresentar características peculiares nas manifestações e evolução da doença. Relatamos o caso de um paciente masculino, HIV-positivo, que desenvolveu um quadro florido de secundarismo: além da roséola sifilítica, apresentou pan-uveíte bilateral e acometimento do sistema nervoso central. A investigação, apresentou fenomeno pro-zona e no estudo histologico, mostrou a presenca de vasculite leucocitoclastica achado este extremamente raro e pouco documentado.

Syphilis, a disease that in the past was associated with significant morbidity and lethality rates, has resurged in recent years principally as a consequence of changes in risk behavior. An epidemiological group that is commonly affected is the HIV-infected population. The characteristics of the disease and its progression may differ in these patients. The present report describes a case of an HIV-positive male patient, who developed florid secondary syphilis: in addition to syphilitic roseola, he also presented with bilateral panuveitis and involvement of the central nervous system. Investigation revealed the prozone phenomenon and histological examination of the skin lesions showed the presence of leukocytoclastic vasculitis. This finding is extremely rare and few cases have been documented.

Leprosy reversal reaction as immune reconstitution inflammatory syndrome in patients with AIDS.

We report 2 instances in which reactional borderline leprosy manifested itself as an immune reconstitution phenomenon in patients with acquired immunodeficiency syndrome. We discuss the clinical, laboratory-based, histopathologic, and immunohistochemical characteristics of both patients. Furthermore, we review similar reports from the literature.

Epidemiology of Kaposi's sarcoma in patients with acquired immunodeficiency syndrome in São Paulo, Brazil.

BACKGROUND: Kaposi's sarcoma (KS) is the most frequent neoplasm in patients with acquired immunodeficiency syndrome (AIDS). Although many studies on KS epidemiology have been performed in other countries, few have been carried out in Brazil despite the high incidence of AIDS. METHODS: One hundred and seven KS patients seen in São Paulo, Brazil, between August 1995 and November 1998 were studied. The patients were followed for 1 year with assessment of the immunologic status, improvement of the lesions, treatment, and causes of death at the end of this period. RESULTS: KS occurred mainly in men (94.4%) with a mean age of 37 years, and 25.2% of these patients were found to be human immunodeficiency virus (HIV) seropositive through KS. HIV was acquired mainly through homosexual contact. The patients presented an average of 15.9 KS lesions at the first visit and the mean duration of KS lesions before the first visit was 15.5 months. The clinical presentation was predominantly papules and plaques, and 33.6% presented with mucosal and/or visceral disease. KS affected mainly the lower limbs. The mean time since the diagnosis of HIV infection was 42.4 months. The CD4+ cell count was lower than 200 cell/mm(3) in 60.8% of patients, but patients with a complete response showed an improvement in immune status after 1 year. Patients who did not show progression received a protease inhibitor as part of highly active antiretroviral therapy (HAART). Patients treated exclusively with HAART presented a complete response (61.6%), partial response (23%) or progression (15.4%) of KS. CONCLUSIONS: An improvement in immune status and the use of HAART were the most important prognostic features.

Manifestações dermatológicas da infecção pelo HIV / Dermatologic manifestations of HIV infection

As lesões cutoneomucosas são bastante freqüentes no paciente infectado pelo HIV e é importante que o dermatologista esteja familiarizado com elas. Nesta revisão são abordados aspectos clínicos, diagnósticos e terapêuticos dos quadrods dermatológicos mais prevalentes nessa população, entre eles infecções (virais, fúngicas e bacterianas), tumores (sarcoma de Kaposi, carcinoma basocelular), farmacodermias, erupções eritêmato-escamosas e papulopruriginosas