Association between palmoplantar pustulosis and cigarette smoking in Brazil: a case-control study.

BACKGROUND: Palmoplantar pustulosis (PPP) discloses some differences compared to vulgar psoriasis (PV) in terms of age of onset, female predominance and low occurrence of psoriasis lesions elsewhere. Cigarette smoking has been associated to PPP in international studies; nevertheless, these studies were never performed among Brazilian. OBJECTIVES: To compare prevalence of smoking among PPP, PV and other dermatologic patients (NPD). METHODS: Case-control study involving 25 PPP patients from a reference psoriasis centre. Two control groups were matched according to gender and age: 50 patients with PV and 50 NPD. Confounders were adjusted by conditional multiple logistic regression. RESULTS: Among cases, 84.0% were female and PPP age of disease onset (41.4 years) was greater than PV (34.5 years). Prevalence of ever smoking was higher among cases (92.0%) than PV (52.0%) and NPD (30.0%). Adjusted odds ratio of PPP ever smoking compared to PV and NPD was 9.5 and 36.2, respectively. All smokers reported the onset of their habit before the development of PPP. CONCLUSIONS: There was significant association between PPP and smoking. However, the impact of giving it up in the clinical course of the disease remains to be established.

Lycopene and beta-carotene protect in vivo iron-induced oxidative stress damage in rat prostate.

It has been suggested that iron overload may be carcinogenic. In the present study, we evaluated the effect of plasma and prostate carotenoid concentration on oxidative DNA damage in 12-week-old Wistar rats treated with intraperitoneal (ip) ferric nitrilotriacetate (Fe-NTA) (10 mg Fe/kg). Plasma beta-carotene and lycopene concentrations were measured as a function of time after ip injection of carotenoids (10 mg kg(-1) day(-1) beta-carotene or lycopene) in rats. The highest total plasma concentration was reached 3 and 6 h after ip injection of lycopene or beta-carotene, respectively. After 5 days of carotenoid treatment, lycopene and beta-carotene were present in the 0.10-0.51 nmol/g wet tissue range in the prostate. Using a sensitive method to detected 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodGuo) by HPLC/EC, the level of 8-oxodGuo in rat prostate DNA was significantly higher (6.3 +/- 0.6 residues/10(6) dGuo) 3 h after Fe-NTA injection compared with control rats (1.7 +/- 0.3 residues/10(6) dGuo). Rats supplemented with lycopene or beta-carotene for 5 days prior to Fe-NTA treatment showed a reduction of about 70% in 8-oxodGuo levels to almost control levels. Compared with control rats, the prostate of Fe-NTA-treated animals showed a 78% increase in malondialdehyde accumulation. Lycopene or beta-carotene pre-treatment almost completely prevented lipid damage. Epidemiological studies have suggested a lower risk of prostate cancer in men reporting a higher consumption of tomato products. However, before associating this effect with tomato sauce constituents, more information is required. The results described here may contribute to the understanding of the protective effects of carotenoids against iron-induced oxidative stress.

Serology of paracoccidioidomycosis. II. Correlation between class-specific antibodies and clinical forms of the disease.

Untreated and previously treated patients with paracoccidioidomycosis were studied for: (i) serum levels of total IgG, IgM and IgA immunoglobulins, by radial immunodiffusion and Paracoccidioides brasiliensis (Pb) antibodies, by indirect immunofluorescence; (ii) correlation between their levels with the clinical forms of the disease; (iii) correlation between the serum titres obtained by tube precipitin with those of anti-Pb IgG, IgM and IgA. In the untreated group, serum IgG levels were significantly increased in patients with the more systemic forms of the disease, especially the acute progressive form. Serum IgA levels were significantly increased in all patients with no statistical difference between clinical forms. Serum IgM levels were normal in all patients. Anti-Pb IgG, IgA and IgM were detected in 97.5%, 32.5% and 45.0% of all cases, respectively. There was a sharp tendency towards higher levels of anti-Pb IgG among those with the acute progressive form (83.4%) in relation to the chronic, more localized forms, mixed form (68.0%) and isolated organic form (55.5%). In the untreated and previously treated group sera, there was positive correlation between the level of anti-Pb IgG and positivity for the tube precipitin test, suggesting that the precipitin-type antibodies are of the IgG class. Broadly, the present data demonstrate a polyclonal activation of the humoral immune system in paracoccidioidomycosis, with a positive relationship between serological results and severity of the disease.

Correlation between cell-mediated immunity and clinical forms of paracoccidioidomycosis.

Cellular immune response to specific and non-specific stimulants was investigated, both in vivo and in vitro, in 29 healthy controls and in 53 previously untreated patients with the chronic isolated organic form (CIOF), the chronic mixed form (CMF) and the acute progressive form (APF) of paracoccidioidomycosis. The study included skin tests to Paracoccidioides brasiliensis antigen (PbAg) and phytohaemagglutinin (PHA), DNCB sensitization, determination of T lymphocytes and complement rosette-forming cells, lymphocyte transformation and leucocyte migration inhibition tests using PbAg and PHA. Patients displayed staggered cutaneous response to PHA and to PbAg, with marked decrease in intensity in the APF group. DNCB sensitization test and proliferative response of lymphocytes to PHA and PbAg were severely depressed in most of the patients. Leucocyte migration inhibition indices to PbAg were highly positive, while response to PHA was slightly decreased regardless of the clinical form. The number of T lymphocytes was reduced in most of patients and in them the number of complement-rosette forming cells was normal. The distribution of patients according to a suppression index, based in the results of the tests employed, revealed a tendency towards an increased degree of cellular immunosuppression from the least severe (CIOF) to the most severe (APF) clinical form of the disease. On the whole, the present study demonstrated a gamut of immunological reactivity in paracoccidioidomycosis.

Complement-mediated-lysis detection of antibodies in paracoccidioidomycosis: a preliminary study.

The objective of this study was to detect the presence of antibodies by the complement-mediated lysis test in patients with paracoccidioidomycosis, before and after treatment, and to correlate them with the clinical form of the disease and with the levels of precipitin and fluorescent anti-P. brasiliensis antibodies. Eighty percent of sera from 15 untreated paracoccidioidomycosis patients showed positive lytic activity indices (greater than or equal to 15%), as opposed to 50% of sera from 24 treated patients. Sera from 29 of 30 control group blood donors showed 0 to 14% lysis. No correlation was observed between lytic antibody levels and precipitin titers or anti-P. brasiliensis total Ig and IgM antibody titers, either in the untreated or treated patient group. Anti-P. brasiliensis lytic antibodies were detected in various clinical forms of paracoccidioidomycosis. This is the first study using living forms of the fungus to detect anti-P. brasiliensis antibodies and opens the possibility of using the lytic antibodies as indicators of active disease.

In vitro response of the brown bullhead catfish (BB) and rainbow trout (RTG-2) cell lines to benzo[a]pyrene.

Established cell lines from rainbow trout (RTG-2) and brown bullhead catfish (BB) were evaluated as bioindicators of benzo[a]pyrene (B[a]P) toxicity with 3-(4,5-dimethyltiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) reduction and neutral red (NR) uptake assays. Cytochrome P450 1A1 (CYP1A1) enzymatic activity was also evaluated, and taken as a biological indicator of the B[a]P induction power by ethoxyresorufin O-deethylase (EROD) and ethoxycoumarin O-deethylase (ECOD) assays. The BB and RTG-2 cells were compared after 1 and 6 days of exposure to B[a]P. The photoactivation of the compound (B[a]PUV) was another parameter taken into consideration. Cytotoxicity was not observed after 1 day of incubation with B[a]P in both cell lines, although the enzymatic activities of ECOD and EROD presented an induction. Apparently, after 1 day, cells did not metabolise sufficient amounts of B[a]P to cytotoxic metabolites. After 6 days of exposure to this compound a significant reduction in cell viability was observed, this reduction being superior to 50% at the highest B[a]P concentrations for the RTG-2 cell line. These results are in agreement with the values observed for the ECOD and EROD induction. The B[a]P cytotoxicity determined in both cell lines could be ascribed to the significant increase of EROD activity by 6 days of exposure. The photoactivation of B[a]P showed marked differences in both cytotoxic assays and CYP1A1 enzymatic activities, for both cell lines. After 1 day of exposure there was a significant reduction in cell viability, superior to 50% for the RTG-2 cell line. However, it was observed that no induction occurred but rather a decrease in ECOD and EROD activities. Six days of incubation with B[a]PUV showed a decrease in cell viability at the highest concentrations for the BB cells and at the lowest concentrations for the RTG-2 cell line, and the CYP1A1 enzymatic activity presented a significant induction. These results and those observed after 1 day of exposure suggest that B[a]PUV acts as a direct-acting toxicant as well as a metabolism-mediated toxicant-like B[a]P. The RTG-2 cells were more sensitive to B[a]P and its toxic metabolites as well as to the photoactivation of the compound, in both exposure times tested. The finding that the cell lines responded to the CYP1A1 induction in a very efficient way gives proof of the applicability of this system to environmental biomonitoring and toxicology.

[Microsporum nanum. A fourth report of human infection in Brazil]. / Microsporum nanum. Quarto relato de infecção humana no Brasil.

The authors present the fourth Brazilian case of human Microsporum nanum (M. nanum) infection. A child of nine months old presents cutaneous dorsal lesions compatible with tinea corporis, which appeared one month before. The culture revealed M. nanum. The lesions resolved spontaneously after a month. Epidemiologic investigation in the patient's place of origin identified swine infected by M. nanum, indicating the probable source of the infection.

[Outbreak of American cutaneous leishmaniasis in Itaporanga, São Paulo (Brazil)]. / Surto de leishmaniose tegumentar americana em Itaporanga, São Paulo (Brasil).

An outbreak of cutaneous leishmaniasis in a small rural settlement, located in the Southern of São Paulo State-Brazil was observed. This region has basic agricultural activities, and has no forests. Two hundred and thirty one persons were evaluated, and the following aspects were observed. 1) 67 individuals (29%) had skin lesions, confirmed by histopathologic study and the Montenegro skin test; 2) of these cases, 40 (59.7%) were males; 3) The youngest patients were 2 years (5 cases), and the oldest, 86 (1 case); 4) the following types of cutaneous lesions, were observed: a) 54 cases (80.6%) had ulcers, 13 (19.4%) had nodules, 4 (5.9%) had verrucose lesions, and 3 (4.4%) had typical scars. In all the cases, the parasite identified was Leishmania (Viannia) braziliensis. The vector captured in the region was Lutzomyia intermedia, a strong anthropophilic sandfly very frequently observed in São Paulo. This study shows that apart from the well-known outbreak observed in the forest environments, leishmaniasis can be transmitted within or around dwellings.

Paracoccidioidomycosis associated with acquired immunodeficiency syndrome. Report of seven cases.

We report the clinical findings and evolution of seven patients (five men and two women), the majority of them intravenous drug users, with paracoccidioidomycosis associated to acquired immunodeficiency syndrome (AIDS). In four of the patients the paracoccidioidomycosis was restricted to the lung and in the three others was generalized with cutaneous involvement. Only two of them had lived recently in rural area, an indication of the possible reactivation of latent focal infection in the other five patients. The recognition of the role of cell-mediated immunity in host defense against Paracoccidioides brasiliensis leds to the prediction of a growing occurrence of the paracoccidioidomycosis-AIDS association in areas that are endemic for these diseases.

[Sporotrichosis of the domestic cat (Felis catus): human transmission]. / Esporotricose do gato doméstico (Felis catus): transmissão humana.

A case of sporotrichosis transmitted by cat to a veterinarian hospital employees is reported. Inquiry at domiciliary area of the cat's owner revealed two other presumable cases of human sporotrichosis transmitted by cats, and confirmed the diagnosis (by culture of Sporothrix schenckii) of disease in three other domestic cats. Feline sporotrichosis is characterized by ulcerative, cutaneous lesions and systemic dissemination, which invariably cause animal's death. The transmission of sporotrichosis to other animals and humans is enhanced by the great amount of fungus present in cat's lesions.

Oral manifestations of secondary syphilis in the elderly - a timely reminder for dentists.

Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum. Cases of syphilis have increased in frequency and are challenging when affecting the elderly. The main causes of increased prevalence of syphilis are sexual promiscuity, lack of knowledge about the disease and decreasing use of barrier protection. Clinically, the oral manifestation of syphilis may resemble other entities, which hampers the correct diagnosis. We report a case of a 79-year-old male with weight loss and feeding difficulties. In the oral cavity there were ulcerative lesions in the hard palate and bilaterally in the buccal mucosa. The incisional biopsy revealed only a non-specific ulceration of the oral mucosa. After 20 days, the patient was re-evaluated and presented maculopapular lesions in the palmar and plantar areas. Positive serological venereal disease reference laboratory (VDRL) tests confirmed the diagnosis of secondary syphilis. The patient was treated with Benzathine penicillin G. After two weeks of treatment the oral lesion disappeared and the patient returned to normal feeding and gained weight. This case report reinforces the need to alert physicians and dentists to include sexually transmitted infections such as syphilis in the differential diagnosis of oral ulcerative lesions in elderly sexually active patients.

Diversity among satellite glial cells in dorsal root ganglia of the rat.

Peripheral glial cells consist of satellite, enteric glial, and Schwann cells. In dorsal root ganglia, besides pseudo-unipolar neurons, myelinated and nonmyelinated fibers, macrophages, and fibroblasts, satellite cells also constitute the resident components. Information on satellite cells is not abundant; however, they appear to provide mechanical and metabolic support for neurons by forming an envelope surrounding their cell bodies. Although there is a heterogeneous population of neurons in the dorsal root ganglia, satellite cells have been described to be a homogeneous group of perineuronal cells. Our objective was to characterize the ultrastructure, immunohistochemistry, and histochemistry of the satellite cells of the dorsal root ganglia of 17 adult 3-4-month-old Wistar rats of both genders. Ultrastructurally, the nuclei of some satellite cells are heterochromatic, whereas others are euchromatic, which may result from different amounts of nuclear activity. We observed positive immunoreactivity for S-100 and vimentin in the cytoplasm of satellite cells. The intensity of S-100 protein varied according to the size of the enveloped neuron. We also noted that vimentin expression assumed a ring-like pattern and was preferentially located in the cytoplasm around the areas stained for S-100. In addition, we observed nitric oxide synthase-positive small-sized neurons and negative large-sized neurons equal to that described in the literature. Satellite cells were also positive for NADPH-diaphorase, particularly those associated with small-sized neurons. We conclude that all satellite cells are not identical as previously thought because they have different patterns of glial marker expression and these differences may be correlated with the size and function of the neuron they envelope.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA): molecular background, virulence, and relevance for public health

Staphylococcus aureus and coagulase-negative Staphylococcus (CoNS) are frequently found in nosocomial environments as the main pathogen in several infections. In 1961, reports of nosocomial S. aureus resistant to methicillin, the drug of choice against penicillin-resistant strains, required new alternatives and vancomycin started being used to treat infections caused by methicillin-resistant S. aureus (MRSA). Community-acquired methicillin-resistant S. aureus (CA-MRSA) was first reported in 1990 affecting patients without risk factors for infection with MRSA of hospital origin. MRSA of community origin harbor the genes responsible for the synthesis of Panton-Valentine leukocidin (PVL), a toxin associated with skin and soft tissue infections and that carries the staphylococcal cassette chromosome mec (SCCmec) type IV. CA-MRSA emergence has caused great impact on the worldwide medical community since the presence of this pathogen in patients without risk factors represents a high risk to public health.

Infiltrative myelopathy by paracoccidioidomycosis. A review and report of nine cases with emphasis on bone marrow morphology.

AIMS: To report nine additional well-defined cases with infiltrative myelopathy by paracoccidioidomycosis (PCM), to describe the specific lesions and infection-related stromal abnormalities, to review the literature on this type of involvement and to introduce a new cause of granulomatous lesions of bone marrow. METHODS AND RESULTS: Different bone marrow specimens were studied (aspirated smears, aspirated clots, biopsy imprints and biopsies) from nine patients with acute or subacute forms of PCM known to have PCM infiltrative myelopathy. CONCLUSIONS: The biopsy specimens were the best for demonstrating bone marrow involvement by PCM. The lesions varied from compact and focal granulomas with few fungal cells to numerous disseminated fungal cells within a loose granulomatous inflammatory reaction, with a continuum between these extremes suggesting a spectrum of immune response to the fungi. Other findings such as bone marrow fibrosis, parenchymal coagulative necrosis and bone necrosis were also observed in the affected areas.

Cytokines released from blood monocytes and expressed in mucocutaneous lesions of patients with paracoccidioidomycosis evaluated before and during trimethoprim-sulfamethoxazole treatment.

BACKGROUND: Mucocutaneous lesions in paracoccidioidomycosis are granulomatous and result from tissue responses to Paracoccidioides brasiliensis, the aetiological agent. OBJECTIVES AND METHODS: In this study we investigate the expression of tumour necrosis factor (TNF)-alpha, interleukin (IL)-10 and transforming growth factor (TGF)-beta1 by immunohistochemistry in skin and mucosa lesions from patients with the chronic form of paracoccidioidomycosis, evaluated before and at day 20 of trimethoprim-sulfamethoxazole treatment. Cytokine production by peripheral blood monocytes was also studied by enzyme immunoassay. RESULTS: Intense immunostaining for TNF-alpha was detected in mononuclear cells that infiltrated granulomas in all skin and mucosa lesions before treatment simultaneously with low IL-10 granular deposits in these cells. At day 20 of treatment, there was reduced TNF-alpha and IL-10 deposition. Immunoreactive TGF-beta1 was observed diffusely in the dermis and generally in the cytoplasm of macrophages and giant cells, before treatment, and as increased TGF-beta1 deposits in the fibrosis area at day 20 of treatment. Peripheral blood monocytes from patients with paracoccidioidomycosis, evaluated before treatment, produced high endogenous levels of TNF-alpha, TGF-beta1 and IL-10 in relation to healthy controls. Lipopolysaccharide-stimulated monocytes from patients secreted lower levels of TNF-alpha in both periods of evaluation while no impairment in capacity of IL-10 and TGF-beta production was observed. CONCLUSIONS: Trimethoprim-sulfamethoxazole therapy was effective in decreasing fungal load in the lesions, allowing patient immune response to control the infection leading to the healing of the lesions.

Subcutaneous phaeohyphomycosis caused by Phaeoacremonium parasiticum in a renal transplant patient.

A 49-year-old renally transplanted man, under a five-year course of immunosuppressive therapy with prednisone and cyclosporine A, experienced a subcutaneous phaeohyphomycosis caused by Phaeoacremonium parasiticum. The clinical presentation consisted of impressive, large, inflammatory and draining cystic tumors on the left foot that had been present for one year. A significant improvement was obtained with itraconazole plus intralesional injection with amphotericin B. Drug interaction was observed between itraconazole and cyclosporine A causing a severe hypertensive crisis and requiring a temporary sharp reduction in cyclosporine administration. Subcutaneous phaeohyphomycosis caused by P. parasiticum is uncommon among major organ transplant patients but several cases have previously been published and some patterns are emerging, e.g., limbs are generally involved but no known traumatic event has preceded lesion development. The identification of the case isolate was confirmed using a recently published online system based in part on beta-tubulin sequence comparison.