Thinking in paracoccidioidomycosis: a delayed diagnosis of a neglected tropical disease, case report and review of clinical reports and eco-epidemiologic data from Colombia since the 2000.

BACKGROUND: Paracoccidioidomycosis is a neglected tropical disease, endemic in several countries of South America including Colombia. We report a case of a patient with Chronic Multifocal Paracoccidioidomycosis with long-standing symptoms and a delayed diagnosis caused by several barriers to achieve it. We did a review of the papers published in Colombia about this disease, focusing in clinical data and eco-epidemiology with the finding of a lack of new information on this topic since the 2000 in our region. CASE PRESENTATION: We present a 54-year-old man, farmer in his youth, with a chronic ulcerated lesion in the lower lip similar to a lip carcinoma, a deforming lesion in the nose, and respiratory symptoms with emphysematous lung. Lip biopsy with silver methenamine stain revealed small and large budding yeasts that resembles a "mariner's wheel" confirming Chronic Multifocal Paracoccidioidomycosis. He was treated successfully but subsequently lost to follow up. CONCLUSIONS: It is very important to focus attention, reinforce the search and create networks for the study of neglected tropical diseases. The presented case illustrates a usual clinical presentation, but with a delayed diagnosis due to the difficulties that still occur in some regions like ours for the early recognition of a case of chronic multifocal paracoccidioidomycosis.

A pilot study of occupational exposure to pathogenic microorganisms through lip cosmetics among dental hygienists.

OBJECTIVES: In dental clinics, dental hygienists are exposed to aerosolized pathologic bacteria, which can be transmitted to the oral cavity via lip cosmetics. Accordingly, such contamination poses a consistent health risk among staffs. Our study examined the bacterial contamination of lip cosmetics used by dental hygienists while in a clinic setting. METHODS: Sixteen dental hygienists were surveyed regarding their job assignments and habits associated with lip cosmetic. Subsequently, microorganisms were analyzed in collected samples of the hygienists' lip cosmetics using colony-forming unit (CFU) assays, 16s-rDNA polymerase chain reaction, and DNA sequencing. RESULTS: Notably, 81.3% of the submitted lip cosmetic samples were contaminated, with bacterial CFUs ranging from undetectable to innumerable. Many samples (43.8%) exceeded the microbial limits of cosmetic contamination. Of the lip cosmetic used for more than 6 months, 60% exceeded the microbial limit. When wearing a mask every time, only one of the six samples exceeded the microbial limit. More frequent dental mask changing was associated with a lower likelihood that the cosmetic sample would exceed the microbial limit. No samples from hygienists who changed their masks four times a day exceeded the microbial limit, compared to 33.3% from hygienists who only changed the mask when it became wet. Most isolated bacteria were gram-positive, facultative anaerobic, asporogenic, and opportunistically pathogenic, and the most prevalent species were Staphylococcus aureus, Streptococcus salivarius, and Staphylococcus epidermidis. CONCLUSION: Our findings indicate that dental staff, including dental hygienists, should exercise more careful workplace habits, particularly with regard to infection control and cosmetic use.

Rational use of antibacterials and drug sensitivity analysis in the repair of large lip defect with skin flap.

In this study the wound status of skin flap repair patients were closely observed, there were sign of infection. The secretion were taken for bacterial culture and sensitivity analysis and given sensitive antibiotics to active treatment. Patients received intravenous antibiotics 30 minutes before surgery to prevent infection. If postoperative infection occurred, according to susceptibility test results, patients were given sensitive antibiotics. Drug sensitivity analysis showed that 85.71% of gram-negative bacteria were sensitive to cefoperazone/shubatan and imipenem and 72.72% of gram-negative bacteria were sensitive to cefoperazone/tazobactam, so these 3 antibiotics were the first choice for treatment. And gram-positive bacteria were sensitive to teicoplanin and vancomycin. Therefore, scientific and rational use of antibiotics has great significance to effectively prevent postoperative infection and reduce the production of drugresistant bacteria. At the same time, L-extension deltopectoral flap was used to reconstruct a full-thickness labiomental defect concurrent infection. All the surgeries were successful without any necrosis. There are many kinds of pathogens for skin flap infection, and their sensitivity to antibiotics is not the same. Therefore, it is suggested that combination therapy should be carried out at the early stage, so as to ensure a good antibacterial effect.

Multiple primary syphilis on the lip, nipple-areola and penis: An immunohistochemical examination of Treponema pallidum localization using an anti-T. pallidum antibody.

Primary syphilis caused by Treponema pallidum usually develops after sexual contact as an initial solitary sclerosis or hard chancre in the genital region. We describe a case of primary syphilis at three sites in genital and extragenital regions of a man who had sex with men. A 29-year-old man visited our hospital for skin lesions on his lower lip, nipple-areola and penis. A positive syphilis serological test for rapid plasma reagin had a titer of 1:16; the patient also tested positive for specific antibodies against T. pallidum, with a cut-off index of 39.0. Histopathological examination of a nipple-areola biopsy specimen revealed a thickened epidermis and dense infiltration of inflammatory cells extending from the upper dermal layers to the deep dermis. The inflammatory cells were composed of abundant lymphocytes, plasma cells, histiocytes and neutrophils. Immunohistochemical staining for T. pallidum using an anti-T. pallidum antibody showed numerous spirochetes in the lower portion of the epidermis, scattered inside inflammatory cell infiltrate and perivascular sites throughout the dermis. Based on these findings, the patient was diagnosed with primary syphilis. Treatment with oral amoxicillin hydrate was started. Five days after starting treatment, a diffuse maculopapular rash (syphilitic roseola) occurred on his trunk and extremities. Perivascular cuffing due to T. pallidum was present throughout the dermis in the biopsy specimen of a localized lesion of primary syphilis. Moreover, syphilitic roseola, which indicates generalized dissemination of T. pallidum, developed during the course of treatment for primary syphilis. Therefore, we considered perivascular cuffing to be indicative of the dissemination phase.

Randomized controlled trial: lip piercing: the impact of material on microbiological findings.

PURPOSE: The purpose of this study was to investigate whether there are microbiological differences in bacterial samples collected from labial piercings made of different materials. METHODS: Sterile piercings of 4 materials were randomly allocated to 80 pierced subjects. After 2 weeks, microbiologic samples were collected and processed by checkerboard DNA-DNA hybridization methods. Wilcoxon signed ranks and Mann-Whitney tests were used for statistical analysis (adjustment for multiple comparisons). RESULTS: There were no statistically significant differences between material groups in relation to baseline data. In samples from stainless steel piercings, the total microbial load was significantly higher than the other materials (P<.05). Ten (mainly periopathogenic) species were found at significantly higher levels (P<.001) on steel than on polypropylene and/or polytetrafluoroethylene piercings. CONCLUSIONS: Labial piercings made of stainless steel could promote the development of a pathogenic biofilm.

Bacterial infection as a likely cause of adverse reactions to polyacrylamide hydrogel fillers in cosmetic surgery.

BACKGROUND: The etiology of long-lasting adverse reactions to gel fillers used in cosmetic surgery is not known. Bacterial infection and immunological reaction to the product have been suggested. METHODS: We performed a case-control study, with 77 biopsies and 30 cytology specimens originating from 59 patients with adverse reactions to polyacrylamide gel, and 54 biopsies and 2 cytology specimens from 28 control subjects with no adverse reactions. Samples from 5 patients and 4 controls could not be investigated for presence of bacteria owing to limited material. Samples from the remaining 54 patients and 24 controls were systematically examined for the presence of bacteria by culture, 16S rRNA gene sequencing, Gram stain, and fluorescence in situ hybridization. RESULTS: Bacteria, mostly normal skin bacteria such as Staphylococcus epidermidis and Propionibacterium acnes, were identified in bacteriologically investigated samples from 53 of 54 patients (98%), and in none of the 24 controls (0%). The bacteria were lying in small clusters, which in symptomatic lesions were detected up to 5 years postinjection. CONCLUSIONS: Commensal bacteria of low virulence are capable of producing long-term infection in the presence of polyacrylamide filler in cosmetic surgery, possibly due to a biofilm mode of growth. Adequate skin preparation and use of sterile technique in these procedures are mandatory, but antibiotic prophylaxis prior to injection of nondegradable gels like polyacrylamide should be explored as well.

Oral lesions in leprosy revisited: a case report.

There is a scarcity of the histopathologically proven lesions of leprosy in the oral cavity, in the world literature. A 55-year-old man had come with a complaint of asymptomatic nodular lesions in the oral cavity. Cutaneous lesions and peripheral nerve examination were suggestive of lepromatous leprosy. Histopathologic examination of a nodule on the palate demonstrated diffuse macrophagic granulomas and acid-fast bacilli.

Orofacial Granulomatosis due to Tuberculosis.

Tuberculosis in a girl with typical features of orofacial granulomatosis is described. The importance of early suspicion and treatment to prevent disfigurement is emphasized.

Oral exfoliative cytology as a rapid diagnostic tool for paracoccidioidomycosis.

Paracoccidioidomycosis is a common deep mycosis in South America. It is caused by the dimorphic fungus Paracoccidioides brasiliensis. We report a case of a 47-year-old Brazilian man with oral lesions due to paracoccidioidomycosis, which was diagnosed by exfoliative cytology without any special staining. We highlight this diagnostic tool as a simple, low-cost, painless, non-invasive and fast method for the diagnosis of paracoccidioidomycosis.

Crack use as a public health problem in Canada: call for an evaluation of 'safer crack use kits'.

Oral crack use (smoking) is a relatively neglected public health problem in Canada, in comparison to injection drug use (IDU). There are indications that crack use in Canada may be increasing. Crack smoking involves particular risks and harms, including possible infectious disease transmission, which underline the need for targeted interventions. One pragmatic grassroots intervention that has only recently begun or been discussed in several Canadian cities is the distribution of 'safer crack use kits', which provide hardware for crack smoking devices along with harm reduction information. In addition to the direct benefits of using them, the kits may also bring previously 'hidden' marginalized crack smokers in contact with health and social services. There has been considerable controversy with regards to the distribution of the crack kits, within criminal justice, public health, and the general public; this resistance appears quite similar to that experienced when needle exchange programs (NEPs) were first being established. Systematic evaluation of the crack kits is urgently needed in order to produce definitive evidence of their health and other benefits, and to allow for evidence-based program and policy decisions in the interest of public health.

Zygomycosis due to Conidiobolus coronatus in west Bengal.

Zygomycosis of upper respiratory tract, caused by Conidiobolus coronatus, in eight Bengalee males and one female is described. The clinical syndrome of the cases included initial coryza, epistaxis, intranasal tumor, nasal obstruction, broadening of bridge of nose with swelling of paranasal sinuses, dorsum of nose, alae nasi, cheek and glabella in all or majority of the cases. In addition upper lip or both lips and pharynx were involved in some cases. Swellings were fixed to the skin in seven cases and to the deeper tissues in five cases. The fungus was demonstrated by direct microscopy in the nasal mucosa, and was isolated in culture. The isolates produced conidia, replicative conidia and villose conidia but not multiplicative conidia. The disease was cured with KI and/or ketoconazole/fluconazole. The cases described here constitute the first report on zygomycosis due to C. coronatus from North-eastern India.

Localization of eosinophil granule major basic protein in paracoccidioidomycosis lesions.

Paracoccidioidomycosis is a chronic granulomatous disease caused by the fungus Paracoccidioides brasiliensis. Although eosinophils have long been associated with the immune defense against helminths, the role of eosinophils in the immune response to fungal diseases is not as well studied. The eosinophil granule major basic protein is toxic to helminths and mammalian cells in vitro, and its release has been used as a marker of eosinophil localization and degranulation. To determine whether eosinophil infiltration and degranulation, as evidenced by the deposition of major basic protein, occur in lesions of P. brasiliensis, we used an immunofluorescence technique to localize the P. brasiliensis organisms and eosinophils and major basic protein. Initially, all tissues were stained with polyclonal antibody to major basic protein; subsequently, colocalization of major basic protein and P. brasiliensis by double staining with mouse and rabbit antibodies, respectively, was performed. Nine biopsy tissues from seven patients were analyzed. All nine biopsies showed infiltration of intact eosinophils using both the monoclonal and the polyclonal anti-major basic protein antibodies, along with the presence of P. brasiliensis. Furthermore, using the polyclonal anti-major basic protein antibody, nine of nine tissues showed extracellular major basic protein deposition (granular or diffuse fluorescence staining outside of intact eosinophils). The double staining procedure using the anti-major basic protein monoclonal antibody showed extracellular deposition in five of eight biopsies; in these five biopsies, approximately 60% of the areas containing P. brasiliensis had extracellular major basic protein deposited on the organisms. These observations support the hypothesis that the eosinophil, through toxic granule proteins such as major basic protein, participates in the pathophysiology of paracoccidioidomycosis.

Expression of sequences homologous to HTLV-I tax gene in the labial salivary glands of Japanese patients with Sjögren's syndrome.

OBJECTIVE: To address the question of whether the human T cell leukemia virus type I (HTLV-I) gene is associated with the etiology of Sjögren's syndrome (SS). METHODS: RNA expression of HTLV-I gag, pol, env, and tax genes in labial salivary glands (LSGs) from SS patients who were seronegative for antibodies to HTLV-I was examined using reverse transcription and polymerase chain reaction techniques. RESULTS: The HTLV-I tax gene, but not the HTLV-I gag, pol, or env genes, was detected in LSG samples from 4 of 14 patients (29%). The nucleotide sequences of the HTLV-I pXIV region in these 4 patients' LSGs showed 100% homology to the HTLV-I pXIV gene from the MT-2 cell line. CONCLUSION: These findings suggest that products encoding sequences homologous to the HTLV-I pXIV gene in SS patients' LSGs might be candidates for self-antigen and/or lead to activation of autoreactive T lymphocytes through trans-acting transcriptional activation.

Candida granuloma and sarcoidosis.

Chronic mucocutaneous candidosis has been described in patients with impaired cell-mediated immunity. We describe a female patient with sarcoidosis who developed a Candida granuloma on her upper lip. Moderate impairment of the cell-mediated immunity was detected. Three months' treatment with ketoconazole was successful, but the lesion recurred at the same place after treatment was stopped.

Rabies-related Yuli virus; identification with a panel of monoclonal antibodies.

Yuli virus was isolated by intracerebral (i.c.) inoculation of suckling mice with a 10% brain suspension from 11-year-old patient who died under signs of atypical hydrophobia after a bat bite into lower lip. Identification with a panel of monoclonal antibodies (MoAb) to nucleocapsid protein (NP) confirmed that Yuli virus belongs to Lyssavirus genus, as an antigenic variant of the European Duvenhage virus.