Rhinoscleroma: eight Peruvian cases.

Rhinoscleroma is a rare infection in developed countries; although, it is reported with some frequency in poorer regions such as Central Africa, Central and South America, Eastern and Central Europe, Middle East, India and Indonesia. Nowadays, rhinoscleroma may be erroneously diagnosed as mucocutaneos leishmaniasis, leprosy, paracoccidioidomycosis, rhinosporidiasis, late syphilis, neoplasic diseases or other upper airway diseases. From 1996 to 2003, we diagnosed rhinoscleroma in eight patients attended in the Dermatologic and Transmitted Diseases service of "Cayetano Heredia" National Hospital, in Lima, Peru. The patients presented airway structural alterations producing nasopharyngeal, oropharyngeal and, in one patient, laryngeal stenosis. Biopsy samples revealed large vacuolated macrophages (Mikulicz cells) in all patients. Ciprofloxacin 500 mg bid for four to 12 weeks was used in seven patients and oxytetracycline 500 mg qid for six weeks in one patient. After follow-up for six to 12 months the patients did not show active infection or relapse, however, all of them presented some degree of upper airway stenosis. These cases are reported because of the difficulty diagnosing the disease and the success of antibiotic treatment.

Rhinoscleroma: eight Peruvian cases / Rinoscleroma: oito casos peruanos

Rhinoscleroma is a rare infection in developed countries; although, it is reported with some frequency in poorer regions such as Central Africa, Central and South America, Eastern and Central Europe, Middle East, India and Indonesia. Nowadays, rhinoscleroma may be erroneously diagnosed as mucocutaneos leishmaniasis, leprosy, paracoccidioidomycosis, rhinosporidiasis, late syphilis, neoplasic diseases or other upper airway diseases. From 1996 to 2003, we diagnosed rhinoscleroma in eight patients attended in the Dermatologic and Transmitted Diseases service of "Cayetano Heredia" National Hospital, in Lima, Peru. The patients presented airway structural alterations producing nasopharyngeal, oropharyngeal and, in one patient, laryngeal stenosis. Biopsy samples revealed large vacuolated macrophages (Mikulicz cells) in all patients. Ciprofloxacin 500 mg bid for four to 12 weeks was used in seven patients and oxytetracycline 500 mg qid for six weeks in one patient. After follow-up for six to 12 months the patients did not show active infection or relapse, however, all of them presented some degree of upper airway stenosis. These cases are reported because of the difficulty diagnosing the disease and the success of antibiotic treatment.

O rinoscleroma é uma infecção rara nos países desenvolvidos, no entanto, tem sido relatado com alguma freqüência nas regiões pobres da Africa Central, América Central e do Sul, Europa Central e Oriental, Oriente Médio, índia e Indonésia. A doença pode ser erroneamente diagnosticada como leishmaniose mucocutânea, hanseníase, paracoccidioidomicose, rinosporidiose, sífilis tardia, neoplasias ou outras doenças que afetam a via respiratória superior. No período de 1996 a 2003, foram diagnosticados oito casos de rinoscleroma no serviço de Doenças Dermatológicas e Infecciosas do Hospital Nacional "Cayetano Heredia", em Lima, Peru. Os pacientes apresentaram alterações estruturais das vias respiratórias, caracterizadas por estenose da nasofaringe e orofaringe, e em um paciente, a nível da laringe. As biópsias mostraram macrófagos com grandes vacúolos (células de Mikulicz). A ciprofloxacina 500 mg de 12/12 horas por quatro a 12 semanas foi usada em sete pacientes e oxitetraciclina 500 mg de 6/6 horas por seis semanas em um paciente. Durante o acompanhamento por seis a 12 meses todos os pacientes apresentaram cura clínica, sem recaída, embora exibissem algum grau de estenose na via respiratória superior. O motivo do relato deve-se ao fato desta doença constituir um grande desafio diagnóstico e pelo sucesso alcançado com o tratamento antibiótico.

A oxitetraciclina na acne vulgar / The oxytetracycline in the acne vulgaris

Foram tratados 30 pacientes com acne vulgar exclusivamente com a oxitetraciclina oral por um periodo de 90 dias avaliados a intervalos regulares. Deu-se preferencia a pacientes virgens de tratamento.Observaram-se resultados muito bons em 16 pacientes com redução acima de 80 por cento do quadro inicial, bons em 6 e regulares em 8 pacientes. Não se observou melhora inferior a 40 por cento ou piora do quadro inicial.Nauseas, vomitos e diarreia leve foram sintomas apresentados na primeira semana de tratamento em 20 por cento dos pacientes. Nenhum cado de fotossemsibilidade do observado.

A terramicina na lepra

Antibiotics, in the authors' opinion, represent a very promising group of drugs against lepromatous leprosy, although the most neglected. Tetracycline group has been known for its broad spectrum of acitivity, a low toxicity rate and a slowly developing type of resistance. All the references in the literature concerning the use of antibiotics in leprosy show how very irregular have been the periods of treatment, the dosage employed, the conditions under which trials were conducted in each group, as well as the lack of uniformity in the choosing of patients and the carryng out of the studies, all this yielding as could not have been otherwise, a disparity of conclusions. In 1964, Mariano, from Belo Horizonte (Brazil) reported good results in the treatment of lepromatous and tuberculoid cases with intramuscular Terramycin at a dosage of 100 mg every 48 hours. Encoureaged by these results the authors undertook a long-term study oxytetracycline in lepromatous leprosy. Twenty-two patients were included and Terramycin pre-constituted solution was applied by intramuscular route in dosages of 100 mg every 12 hours, during 12 months or so. For therapeutic control the test indicated below were performed. 1. Dermatological examination at the beginning ot treatment and on monthly intervals; 2. Bacilloscopic examination of mucus and skin lesions at the beginning of treatment, and on monthly; 3. Histopathological examination of biopsies taken at the beginning of treatment, and 6 and 12 months thereafter; 4. Color photos on starting treatment and 6 months later, eventually even every month. Nineteen patient presented circunscribed lesions with predominant papules, tubercles and nodules. Thw reamaining theree cases had erythema and diffuse infiltration. All of the 22 patients treated with oxytetracycline improved clinically. On the average, imoprovement took place between the first and the third month of treatment; from there on, involution of the lesions slowed down...