Differential diagnosis of exanthematous viruses during the 2022 Mpox outbreak in Minas Gerais, Brazil.

The monkeypox virus (MPXV) outbreak, primarily endemic to Africa, has spread globally, with Brazil reporting the second-highest number of cases. The emergence of MPXV in non-endemic areas has raised concerns, particularly due to the co-circulation of other exanthematous viruses such as varicella-zoster virus (VZV) and molluscum contagiosum virus (MOCV). To perform an accurate differential diagnosis of MPXV during the ongoing outbreak in Minas Gerais, Brazil, a 5PLEX qPCR assay targeting orthopoxviruses (OPV), VZV, and MOCV was used to retrospectively analyze all clinical samples that tested negative for MPXV in the initial screening conducted at Funed. In summary, our study analyzed 1,175 clinical samples received from patients suspected of MPXV infection and found a positivity rate of 33.8% (397 samples) for MPXV using the non-variola qPCR assay. Testing the 778 MPXV-negative clinical samples using the 5PLEX qPCR assay revealed that 174 clinical samples (22.36%) tested positive for VZV. MOCV DNA was detected in 13 and other OPV in 3 clinical samples. The sequencing of randomly selected amplified clinical samples confirmed the initial molecular diagnosis. Analysis of patient profiles revealed a significant difference in the median age between groups testing positive for MPXV and VZV and a male predominance in MPXV cases. The geographic distribution of positive cases was concentrated in the most populous mesoregions of Minas Gerais state. This study highlights the challenges posed by emerging infectious diseases. It emphasizes the importance of epidemiological surveillance and accurate diagnosis in enabling timely responses for public health policies and appropriate medical care. IMPORTANCE: Brazil ranks second in the number of cases during the global monkeypox epidemic. The study, conducted in Minas Gerais, the second most populous state in Brazil with over 20 million inhabitants, utilized differential diagnostics, revealing a significant number of positive cases for other exanthematous viruses and emphasizing the need for accurate diagnoses. During the study, we were able to assess the co-circulation of other viruses alongside monkeypox, including varicella-zoster virus, molluscum contagiosum virus, and other orthopoxviruses. The significance of the research is underscored by the concentration of positive cases in populous areas, highlighting the challenges posed by emerging infectious diseases. This demographic context further amplifies the importance of the research in guiding public health policies and medical interventions, given the substantial population at risk. The study not only addresses a global concern but also holds critical implications for a state with such a large population and geographic expanse within Brazil. Overall, the study emphasizes the pivotal role of surveillance and precise diagnosis in guiding effective public health responses and ensuring appropriate medical interventions.

Molusco contagioso del párpado: manifestación cutánea de inmunosupresión / Eyelid molluscum contagiosum: Cutaneous manifestation of immunosuppression

Resumen El molusco contagioso es una infección viral cutánea, usualmente benigna y autolimitada, causada por un virus del género Molluscipoxvirus. Es más frecuente en niños, adultos jóvenes sexualmente activos e inmunosuprimidos. La lesión clínica característica es una pápula umbilicada eucrómica o de tono perlado, que se disemina rápidamente y puede afectar cualquier superficie muco-cutánea, aunque la localización en los párpados es atípica. Se presentan dos casos de pacientes jóvenes inmunosuprimidos, con moluscos contagiosos palpebrales, en quienes el diagnóstico clínico inicial fue incorrecto. Se enfatiza la importancia de diagnosti car oportunamente las lesiones papulares que afectan la piel del párpado ya que la presencia de molusco contagioso en esta zona se considera una manifestación cutánea de inmunosupresión.

Abstract Molluscum contagiosum is a cutaneous viral infection, usually benign and self-limited, caused by the molluscum contagiosum virus, of the genus Molluscipoxvirus. It is more common in pediatric population, sexually active young people and immunosuppressed patients. Clinical presentation is characterized by umbilicated white to flesh-colored or pearly papules, which rapidly spread and can affect any muco-cutaneous membrane. Although the eyelid presentation is atypical, we herein present two young, immunosuppressed patients, with diagnosis of palpebral molluscum contagiosum, in which the initial clinical diagnosis was wrong. We emphasize the importance in making a timely diagnosis of papular lesions localized on the eyelids and the correlation of these lesions as a cutaneous manifestation of immunosuppression.

Clinical remission of disseminated molluscum contagiosum infection in a patient with atopic dermatitis treated with dupilumab.

Atopic dermatitis predisposes to skin infections, and on the other hand, some therapies used for atopic dermatitis may worsen viral infections whose lesions may be more diffuse and resistant to treatment. The authors present a patient with severe atopic dermatitis and disseminated molluscum contagiosum infection. The molluscum contagiosum did not clear with topical treatment, and it worsened her atopic dermatitis even more, so the authors started treatment with dupilumab. After two months, the patient's dermatitis went into clinical remission and there was resolution of the infection with no recurrence at the 12-month follow-up. Dupilumab is nowadays a promising treatment for severe atopic dermatitis. To our knowledge, only four reports of molluscum contagiosum during dupilumab therapy have been reported in the literature, with contrasting effects. According to the authors' experience, treatment with dupilumab appears to be a safe alternative for patients with severe atopic dermatitis who are also infected with molluscum contagiosum, as opposed to other treatments such as systemic corticosteroids or cyclosporine.

Clinical remission of disseminated molluscum contagiosum infection in a patient with atopic dermatitis treated with dupilumab

Abstract Atopic dermatitis predisposes to skin infections, and on the other hand, some therapies used for atopic dermatitis may worsen viral infections whose lesions may be more diffuse and resistant to treatment. The authors present a patient with severe atopic dermatitis and disseminated molluscum contagiosum infection. The molluscum contagiosum did not clear with topical treatment, and it worsened her atopic dermatitis even more, so the authors started treatment with dupilumab. After two months, the patient's dermatitis went into clinical remission and there was resolution of the infection with no recurrence at the 12-month follow-up. Dupilumab is nowadays a promising treatment for severe atopic dermatitis. To our knowledge, only four reports of molluscum contagiosum during dupilumab therapy have been reported in the literature, with contrasting effects. According to the authors' experience, treatment with dupilumab appears to be a safe alternative for patients with severe atopic dermatitis who are also infected with molluscum contagiosum, as opposed to other treatments such as systemic corticosteroids or cyclosporine.

Molluscum Contagiosum Associated with Acquired Immunodeficiency Syndrome: Experience in HIV outpatient care and literature review / Molusco contagioso associado à síndrome da imunodeficiência adquirida: experiência no atendimento em ambulatório de HIV e revisão da literatura

Introduction: Molluscum contagiosum is a dermatosis caused by a DNA virus of the family Poxvirus and genus Molluscipoxvirus, affecting mainly children, sexually active adults, atopic individuals and immunocompromised patients, especially those with human immunodeficiency virus (HIV) infection. Objective: To describe our experience in caring for patients living with HIV who presented with extensive and severe Molluscum contagiosum, and to conduct a literature review on the subject as well. Methods: An electronic search was carried out in the MEDLINE/PubMed and SciELO databases and in the books: ATLAIDS and AZULAY limited to the period of January 2017 to June 2021. Results: Four clinical cases are reported in people living with HIV with extensive lesions normally not found in immunocompetent patients. The treatment performed in the cases reported in this article was the punctual application of 90% trichloroacetic acid (TCA) to each lesion, with complete remission of the clinical presentation in two patients over a period of three and six months. The other two patients did not receive treatment for molluscum contagiosum as they died because of pulmonary complications. Conclusion: Infection with Molluscum contagiosum in people living with HIV has disseminated forms with large-volume lesions, with substantial stigmatizing aesthetic impairment, and treatment with 100% TCA is quite effective.

Introdução: Molusco contagioso é uma dermatose causada por um vírus de DNA da família poxvírus e do gênero Molluscipoxvirus. Afeta principalmente crianças, adultos sexualmente ativos, indivíduos atópicos e pacientes imunodeprimidos, especialmente aqueles com infecção pelo vírus da imunodeficiência humana (HIV). Objetivo: Descrever a experiência no atendimento de pacientes vivendo com HIV que apresentaram quadro de molusco contagioso extenso e grave, além de realizar uma revisão da literatura sobre o tema. Métodos: Foi realizada uma pesquisa eletrônica nas bases de dados MEDLINE/PubMed e SciELO e nos livros ATLAIDS e AZULAY, limitada ao período de janeiro de 2017 a junho de 2021. Resultados: São relatados quatro casos clínicos em pessoas que vivem com HIV com lesões extensas normalmente não encontradas em pacientes imunocompetentes O tratamento realizado nos casos relatados nesse artigo foi a aplicação pontual de ácido tricloroacético (ATC) 100% em cada lesão, com a remissão completa do quadro clínico em dois pacientes em um período de tempo entre três e seis meses. Os outros dois pacientes não receberam tratamento para o vírus do molusco contagioso pois evoluíram para óbito em razão de complicações pulmonares. Conclusão: A infecção pelo molusco contagioso em pessoas vivendo com HIV apresenta formas disseminadas com lesões de grande volume, com comprometimento estético estigmatizante importante, e o tratamento com ATC 90% é bastante eficaz.

Molusco contagioso como complicação de tatuagem: um relato de caso e revisão da literatura / Molluscum contagiosum as a tattoo complication: a case report and literature review

A tatuagem é uma prática antiga e muito popular atualmente. Os pigmentos utilizados mudaram com o tempo, mas continuam apresentando composições variadas e pouco regulamentadas. Há inúmeros casos descritos de efeitos adversos pós-tatuagem, em sua maioria infecciosos, e reações de hipersensibilidade. Relatamos o caso de uma mulher de 64 anos, hígida, com pápulas nas sobrancelhas um mês após realizar micropigmentação. A biópsia excisional fez o diagnóstico de molusco contagioso, e o tratamento foi realizado com curetagem das lesões. Na literatura, existem poucos relatos de disseminação de molusco contagioso causada por tatuagem.

Tattooing is an ancient practice and very popular nowadays. The pigments used have changed over time but still present varied and poorly regulated compositions. There are many described cases of adverse effects after tattooing, mainly infectious and hypersensitivity reactions. We report the case of a 64-yearold woman, healthy, with papules on her eyebrows one month after performing micropigmentation. The excisional biopsy diagnosed molluscum contagiosum, and the lesions were curetted. There are few reports in the literature of the spread of molluscum contagiosum caused by tattooing

Presentación atípica de molusco contagioso: compromiso ocular bilateral en paciente con VIH / Atypical presentation of molluscum contagiosum: bilateral ocular involvement in a patient with HIV

La infección por molusco contagioso (MC) en adultos se asocia frecuentemente a transmisión sexual y/o inmunodepresión, por ejemplo, por VIH. En este grupo, la manifestación clínica suele ser atípica. A continuación, se presenta el caso de un paciente con diagnóstico de VIH, bajo recuento de CD4 y carga viral elevada que consulta por múltiples MC en genitales, tronco, cara y ojos además de conjuntivitis en ojo derecho. Se mantuvo terapia antirretroviral (TARV) y se indicó tratamiento para conjuntivitis. La infección por MC en pacientes con VIH se asocia a etapas SIDA con un aumento de los casos a menor recuento de linfocitos CD4, generalmente menor a 200 cel/mL. La pobre respuesta inmune celular de estos pacientes explica su comportamiento clínico atípico. Este grupo presenta una mayor mortalidad que el de pacientes seropositivos sin MC, lo que se explica por la mayor inmunosupresión asociada. El diagnóstico es clínico, aunque podría verse entorpecido cuando hay compromiso ocular por la presencia de lesiones atípicas que hacen necesario considerar diversos diagnósticos diferenciales. El tratamiento es controversial y tiende a existir una baja respuesta y recidiva frente a terapias convencionales en pacientes con VIH cuando la inmunosupresión es marcada por el recuento CD4 muy bajo. La TARV pareciera ser la mejor alternativa para su tratamiento, sin embargo, es importante considerar posibles complicaciones asociadas, como la instauración de síndrome de restauración inmunológica una vez iniciada. Esto podría traducirse en lesiones oculares graves cuando existe compromiso en este órgano

Molluscum contagiosum (MC) infection in adults is frequently associated with sexual transmission and / or immunosuppression, for example by HIV. In this group, the clinical manifestation is usually atypical. Herein we present the case of a patient with a diagnosis of HIV, a low CD4 count and a high viral load who consulted for multiple MC in the genitals, trunk, face and eyes, as well as conjunctivitis in the right eye. Antiretrovitral therapy (ART) was maintained and treatment for conjunctivitis was indicated. MC infection in HIV patients is associated with AIDS stages with an increase in cases with a lower CD4 lymphocyte count, generally less than 200 cells / mL. The poor cellular immune response of these patients explains their atypical clinical behavior. This group presents a higher mortality than that of seropositive patients without MC, which is explained by the greater associated immunosuppression. The diagnosis is clinical, although it could be hampered when there is ocular compromise due to the presence of atypical lesions that make it necessary to consider various differential diagnoses. Treatment is controversial and there tends to be a poor response and relapse to conventional therapies in patients with HIV when immunosuppression is marked by a very low CD4 count. ART seems to be the best alternative for its. However, it is important to consider possible associated complications such as the onset of immune restoration syndrome once it has been started. This could translate into serious eye injuries when this organ is compromised

Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment.

Molluscum contagiosum (MC) is a self-limited infectious dermatosis, frequent in pediatric population, sexually active adults, and immunocompromised individuals. It is caused by molluscum contagiosum virus (MCV) which is a virus of the Poxviridae family. MCV is transmitted mainly by direct contact with infected skin, which can be sexual, non-sexual, or autoinoculation. Clinically, MC presents as firm rounded papules, pink or skin-colored, with a shiny and umbilicated surface. The duration of the lesions is variable, but in most cases, they are self-limited in a period of 6-9 months. The skin lesions may vary in size, shape, and location, which is more frequent in immunosuppressed patients, and could present complications such as eczema and bacterial superinfection. The diagnosis is based on clinical findings. A useful clinical tool is dermoscopy. If the diagnostic doubt persists, confocal microscopy or skin biopsy could be performed. The need for active treatment for MC is controversial; however, there is a consensus that it should be indicated in cases of extensive disease, associated with complications or aesthetic complaints. There are several treatment modalities which include mechanical, chemical, immunomodulatory, and antivirals. The objective of this article is to review the current evidence in etiology, clinical manifestations, diagnosis, and management alternatives of MC.

Dermoscopic rosettes as a clue for atypical molluscum contagiosum / Rosetas dermatoscópicas como pista para el molusco contagioso atípico

El molusco contagioso (MC) es una infección viral frecuente, generalmente fácil de diagnosticar gracias a sus manifestaciones clínicas características. Sin embargo, las presentaciones clínicas atípicas pueden suponer un desafío diagnóstico. La dermatoscopia ha ayudado en estos casos complejos, al mostrar un patrón dermatoscópico característico compuesto por un poro central o umbilicación junto con estructuras amorfas polilobulares de color blanco a amarillo, rodeadas de vasos lineales o ramificados ('vasos en corona"). Sin embargo, se pueden encontrar patrones dermatoscópicos adicionales. Presentamos dos casos de MC donde se observaron rosetas en la dermatoscopia.

Molluscum contagiosum (MC), a frequent viral infection, is generally easy to diagnose because of its characteristic clinical features. However, atypical presentations can be a diagnostic challenge for clinicians. Dermoscopy has helped in this cases by showing a characteristic dermoscopic pattern composed of a central pore or umbilication in conjunction with polylobular white to yellow amorphous structures, surrounded by linear or branched vessels ('red crown"). However, additional dermoscopic patterns can be found. Herein we present two MC cases where rosettes were seen on dermoscopy

Cambios electrocardiográficos en pacientes con VIH con y sin inhibidores de proteasa vs NNRTI / Differences in electrocardiographic changes in HIV patients with and without treatment with protease inhibitors vs NNRTI

Resumen ANTECEDENTES La infección por el virus de inmunodeficiencia humana (VIH) incrementa la prevalencia de prolongación del intervalo QT corregido (QTc), lo que es un factor independiente de eventos de enfermedad cardiovascular en esta población. En la bibliografía mundial se asocia este cambio con la administración de los antirretrovirales inhibidores de proteasa y efavirenz. Sin embargo, no se conocen datos de estos cambios en la población mexicana. MATERIAL Y MÉTODO Estudio prospectivo observacional en el que se seleccionaron expedientes de marzo de 2015 a mayo de 2016 de la consulta externa del Instituto Nacional de Enfermedades Respiratorias (INER); se dividieron en dos grupos: sin tratamiento, por reciente diagnóstico, y con tratamiento antirretroviral. Se registraron datos clínicos, tratamiento farmacológico, electrocardiograma y química sanguínea. RESULTADOS No se encontraron diferencias entre ambos grupos respecto a edad ni electrólitos séricos. Tampoco se encontró relación entre la prolongación del QTc con efavirenz o los inhibidores de proteasa. Raltegravir disminuyó la duración del QTc (p = 0.001) mientras que la coinfección por molusco contagioso se asoció con prolongación del QTc (p = 0.02). CONCLUSIÓN En nuestro estudio no logramos demostrar en población mexicana relación de la prolongación del QTc con los antirretrovirales de primera ni segunda línea. Se requieren más estudios para determinar la importancia clínica del efecto de raltegravir y molusco contagioso en el QTc.

Abstract BACKGROUND Human immunodeficiency virus (HIV) infection increases the prevalence of QTc prolongation (QTc), which is an independent factor of cardiovascular disease events in this population. In the world literature this change is associated with the use of the protease inhibitors and efavirenz antiretrovirals. However, no data are available on these changes in the Mexican population. MATERIAL AND METHOD A prospective observational study was done selecting records from March 2015 to May 2016 of the external consultation of the National Institute of Respiratory Diseases (INER), Mexico City; they were divided into two groups, those without treatment, because recent diagnosis, and with antiretroviral treatment. We recorded clinical data, pharmacological treatment, electrocardiogram and blood chemistry. RESULTS We found no differences between the two groups regarding age or serum electrolytes. We found no association between QTc prolongation and efavirenz or protease inhibitors. Raltegravir decreased QTc duration (p = 0.001) while molluscum contagiosum coinfection was associated with QTc prolongation (p = 0.02). CONCLUSION In our study, we failed to demonstrate in Mexican population association of QTc prolongation with first- and second-line antiretrovirals. More studies are needed to determine the clinical significance of the effect of raltegravir and molluscum contagiosum on QTc.

Update on the Treatment of molluscum Contagiosum in children. / Actualización sobre el tratamiento de moluscos contagiosos en los niños.

Molluscum contagiosum is one of the most common viral infections in childhood. It is a benign and usually self-limiting infection, but its treatment in children can be challenging, particularly when the patient presents multiple lesions or when lesions are symptomatic or highly visible. Several treatment options exist. Choice of treatment depends on the number and location of lesions, the prior experience of the treating physician, and the preferences of the child's parents or carers. This article provides an update on treatment options for molluscum contagiosum, with a particular focus on immunocompetent pediatric patients.

Tratamento de Molusco Contagioso em crianças: uma revisão sistemática de literatura / Molluscum Contagiosum treatment in children: a systematic literature review / Tratamiento del molusco contagioso en niños: una revisión sistemática de la literatura

Objetivo: Molusco contagioso é uma infecção cutânea, causada pelo Molluscipox vírus. Diante da inexistência de um tratamento específico, esta pesquisa tem como objetivo verificar, segundo a literatura recente, os melhores métodos de tratamento em crianças imunocompetentes. Métodos: Revisão sistemática de literatura realizada no PubMed, bem como no Lilacs, Scielo, Medline e demais bases de dados abrangidas na Biblioteca Virtual em Saúde (BVS), com publicações de 2010 a 2016. Para evitar viés, foram utilizadas recomendações do PRISMA. Critérios do Oxford Centre for Evidence-Based Medicine e do sistema GRADE foram usados para classificação do nível de evidência dos estudos. Resultados: Curetagem, laser pulsado de contraste, crioterapia, exérese cirúrgica, KOH 2,5%, 5% e 10%, ácido tricloroacétrico, combinação de ácido lático e ácido salicílico, tretinoína 0,05% apresentaram boa proporção de cura, facilidade de realização e tempo de resolução. Os métodos de injeção intralesional do antígeno da Cândida e da vacina MMR, dieta balanceada, óleo de Malaleuca alternifólia e Ingenol Mebutate 0,05% mostraram-se promissores. Entretanto, cantaridina e imiquimod 5% creme não foram recomendados. Conclusão: As evidências obtidas não permitem indicar um método preferencial. A escolha do método de tratamento deve ser individualizada. Recomenda-se realizar mais pesquisas voltadas para cultura do vírus.

Objective: Molluscum contagiosum is a skin infection caused by the Molluscipox virus. Given the absence of a specific treatment, this study aims to verify according to recent literature the best methods for molluscum contagiosum treatment in immunocompetent children. Methods: This study is a systematic review conducted in PubMed, as well as Lilacs, Scielo, Medline and other data bases from the Biblioteca Virtual em Saúde (BVS), including publications from 2010 to 2016. The bias is avoided by using PRISMA recommendations . Criteria of the Oxford Center for Evidence-Based Medicine and the GRADE system were used to rank the level of evidence of the studies. Results: Curettage, pulsed dye laser, cryotherapy, surgical abscission, KOH 2.5%, 5% and 10%, trichloroacetic acid, combination of lactic acid and salicylic acid and 0.05% tretinoin showed good performances regarding cure rate, ease of implementation and resolution time. Moreover, methods such intralesional injection of antigen Candida and the MMR vaccine, balanced diet, Malaleuca oil alternifolia and ingenol Mebutate 0.05% showed relevant results. However, the use of cantharidin and imiquimod 5% cream is not recommended. Conclusion: It is not possible to indicate the most eligible method based on the evidence found. Therefore, treatment should be individualized. Future researches about the virus culture are recommended.

Objetivo: El molusco contagioso es una infección de la piel causada por el virus Molluscipox. Dada la ausencia de un tratamiento específico, la presente investigación tiene como objetivo verificar, de acuerdo con la literatura reciente, los mejores métodos de tratamiento en niños inmunocompetentes. Métodos: Revisión sistemática de la literatura realizada en el Pubmed, así como en Lilacs, Scielo, Medline y otras bases de datos en la Biblioteca Virtual de Salud (BVS), con publicaciones de 2010 a 2016. Para evitar sesgos, se utilizaron las recomendaciones del PRISMA. Se utilizaron los criterios del Centro de Oxford para la Medicina Basada en la Evidencia y el sistema GRADE para clasificar el nivel de evidencia de los estudios. Resultados: Curetaje, láser pulsado de contraste, crioterapia, exéresis quirúrgica, KOH 2,5%, 5% y 10%, ácido tricloroacétrico, la combinación de ácido láctico y ácido salicílico, tretinoína 0,05% exhibieron buena tasa de curación, facilidad de realización y tiempo de resolución. Los métodos de inyección intralesional de antígenos de Cándida y la vacuna triple vírica, dieta equilibrada, aceite de alternifolia Malaleuca y ingenol mebutate 0,05% se muestran prometedores. Sin embargo, no se recomienda las cremas de cantaridina y imiquimod al 5%. Conclusión: Las evidencias obtenidas no han elegido un método preferido. La elección del método de tratamiento debe ser individualizada. Se recomienda la realización de más investigaciones relcionadas con el cultivo del virus.

Imiquimode e curetagem para o tratamento do molusco contagioso: um estudo comparativo / Imiquimod and curetage for the treatment of molluscum contagiosum: a comparative study

Introdução: Molusco contagioso é uma dermatovirose causada por um poxvírus. Na literatura há descrição de diferentes abordagens terapêuticas dessa infecção. Objetivo: Avaliar a eficácia do imiquimode para tratamento de molusco contagioso de forma isolada e associada à curetagem. Métodos: Grupo A, 20 pacientes utilizaram imiquimode 5% creme, 3 vezes por semana por 6 semanas e Grupo B, 10 pacientes que utilizaram creme base, 3 vezes por semana por 6 semanas. Após estas 6 semanas, todos os pacientes se submeteram à curetagem. Resultados: Grupo A, na sexta semana diminuição de 31% no número de lesões, com uma efetividade da curetagem de 97,6%; Grupo B na sexta semana um aumento de 4,8% no número de lesões e uma efetividade da curetagem de 81,1%. A média do nível de dor durante a curetagem foi de 1,8 para o Grupo A e 3,0 para o Grupo B. Conclusões: Por aumentar a taxa de eliminação de lesões de molusco contagioso e diminuir a dor quando o processo de curetagem é realizado após uso do imunomodulador, concluímos que a associação de imiquimode 5% em creme com curetagem possa ser uma possibilidade terapêutica.

Introduction: Molluscum contagiosum is a dermatovirosis caused by a poxvirus. In the literature there are descriptions of different therapeutic approaches of this infection. Objective: To evaluate the efficacy of imiquimod ­ isolated and associated with curettage ­ in the treatment of molluscum contagiosum. Methods: Group A: 20 patients used 5% imiquimod cream 3 times a week for 6 weeks. Group B: 10 patients used a creamy base 3 times a week, for 6 weeks. After the initial 6 weeks, all patients underwent curettage. Results: Group A: 31% decrease in the number of lesions in the 6th week, with a curettage effectiveness of 97.6%; Group B: 4.8% increase in the number of lesions in the 6th week, with a curettage effectiveness of 81.1%. The mean value for the pain level during curettage was 1.8 for Group A and 3.0 for Group B. Conclusions: Due to the facts that the rate of cure of contagious molluscum lesions increased and the pain decreased when the curettage procedure was conducted after the use of the immunomodulator, it was possible to conclude that the association of 5% imiquimod cream to the curettage may be a therapeutic possibility.

Milia-like calcinosis cutis in a girl with Down syndrome

Abstract: Milia-like idiopathic calcinosis cutis (MICC) is a very rare dermatological disorder characterized by multiple whitish to skin colored, milia-like papules, mostly found on the hands. MICC can disappear spontaneously by adulthood; therefore, its early recognition is crucial to avoiding unnecessary interventions. Herein, we present a case of MICC in a 6-year-old girl with Down syndrome.

Molluscum contagiosum: posible papel patogenésico en las enfermedades autoinmunes. Reporte preliminar de 111 casos / Molluscum contagiosum: possible role in pathogenesis of autoimmune diseases. preliminary report of 111 cases

Objetivo: mostrar los resultados de una casuística de 111 pacientes diagnosticados por clínica del virus del molusco contagioso (VMC), en los cuales existe una alta prevalencia de enfermedades autoinmunes y de patologías dermatológicas crónicas. Aunque la infección dérmica por el virus del molusco contagioso (VMC) se conoce hace más de 140 años, es sólo durante el presente siglo que se ha difundido el conocimiento de esta patología, en gran parte porque ha existido un aumento alarmante en su incidencia y prevalencia. La bibliografía disponible destaca su larga evolución y resistencia a los tratamientos en boga, ninguno aprobado por la Administración de Alimentos y Medicamentos de los Estados Unidos (FDA, por sus siglas en inglés), pero no menciona complicación del VMC (excepto la sobre infección originada por el rascado). Además de una revisión actualizada de esta dermatosis, el presente artículo muestra una casuística de 111 pacientes (desde infantes de 3 meses hasta adultos de 58 años), portadores del VMC en los cuales parece existir una alta incidencia de patologías reactivas, todas ellas con un patrón de actividad autoinmune y relacionadas en tiempo al inicio del cuadro viral. Conclusión: aunque los resultados preliminares presentados requieren de un mejor manejo estadístico y metodológico, los datos sugieren fuertemente una probable relación entre el VMC y las enfermedades autoinmunes (EAI). Es un hecho que se requieren estudios confirmativos más extensos que avalen o rechacen dicha asociación. (AU)

Objective: to show the cohort of 111 patients clinically diagnosed of molluscum contagiosum virus (MCV or VMC), in who exists a very high prevalence of autoimmune diseases (AID or EAI) and chronic dermatologic conditions. Despite the clinical entity of VMC has been described in medical literature 140 years ago, just present century has brought awareness of its clinical aspects, diagnosis and treatment, mainly because of the explosive spreading of this highly contagious dermatitis. Even when there are several proposed treatments for this virus, no one has been conclusively effective for its eradication and no one has been approved by FDA. Beside an update of clinical picture of VMC, this paper presents a cohort of 111 patients, all of them clinically diagnosed of VMC, aged from 3 months to 58 years; interestingly patients show a very high coexistence of autoimmune diseases and chronic dermatologic conditions as rosaceous, oral and skin lichen. (AU)

Molluscum contagiosum: posible papel patogenésico en las enfermedades autoinmunes. Reporte preliminar de 111 casos / Molluscum contagiosum: possible role in pathogenesis of autoimmune diseases. preliminary report of 111 cases

Mostrar los resultados de una casuística de 111 pacientes diagnosticados por clínica del virus del molusco contagioso (VMC), en los cuales existe una alta prevalencia de enfermedades autoinmunes y de patologías dermatológicas crónicas. Aunque la infección dérmica por el virus del molusco contagioso (VMC) se conoce hace más de 140 años, es sólo durante el presente siglo que se ha difundido el conocimiento de esta patología, en gran parte porque ha existido un aumento alarmante en su incidencia y prevalencia. La bibliografía disponible destaca su larga evolución y resistencia a los tratamientos en boga, ninguno aprobado por la Administración de Alimentos y Medicamentos de los Estados Unidos (FDA, por sus siglas en inglés), pero no menciona complicación del VMC (excepto la sobre infección originada por el rascado). Además de una revisión actualizada de esta dermatosis, el presente artículo muestra una casuística de 111 pacientes (desde infantes de 3 meses hasta adultos de 58 años), portadores del VMC en los cuales parece existir una alta incidencia de patologías reactivas, todas ellas con un patrón de actividad autoinmune y relacionadas en tiempo al inicio del cuadro viral. Conclusión: aunque los resultados preliminares presentados requieren de un mejor manejo estadístico y metodológico, los datos sugieren fuertemente una probable relación entre el VMC y las enfermedades autoinmunes (EAI). Es un hecho que se requieren estudios confirmativos más extensos que avalen o rechacen dicha asociación...

To show the cohort of 111 patients clinically diagnosed of molluscum contagiosum virus (MCV or VMC), in who exists a very high prevalence of autoimmune diseases (AID or EAI) and chronic dermatologic conditions. Despite the clinical entity of VMC has been described in medical literature 140 years ago, just present century has brought awareness of its clinical aspects, diagnosis and treatment, mainly because of the explosive spreading of this highly contagious dermatitis. Even when there are several proposed treatments for this virus, no one has been conclusively effective for its eradication and no one has been approved by FDA. Beside an update of clinical picture of VMC, this paper presents a cohort of 111 patients, all of them clinically diagnosed of VMC, aged from 3 months to 58 years; interestingly patients show a very high coexistence of autoimmune diseases and chronic dermatologic conditions as rosaceous, oral and skin lichen...

Giant Molluscum Contagiosum in an HIV positive patient.

Molluscum Contagiosum (MC) is a skin infection caused by a double-stranded DNA virus of the family Poxviridae that replicates in the human epidermis, affecting mainly children and young sexually active adults and causing flesh colored papular lesions with central umbilication with an average size of 3-5mm, although atypical lesions that reach great size (Giant Molluscum Contagiosum), 10-15mm, can be seen in almost any immunodeficiency condition. We report the case of a 35 year old male patient with C3 HIV disease with an abdominal pathology associated to skin lesions predominantly in the forehead and scalp that reached sizes over 5mm, diagnosed as Giant Molluscum Contagiosum by skin biopsies.

Atypical infantile genital Molluscum contagiosum

Abstract Genital molluscum contagiosum is rare in children. We report a molluscum contagiosum around the vulva and anus of 9-year-old girl, which has atypical presentations and was finally confirmed by histopathological and electron microscopy findings.

Inmunodeficiencia combinada con compromiso cutáneo asociada a mutación en DOCK8 / Combined immunodeficiency with cutaneous manifestations associated with DOCK8 mutation

Diferentes inmunodeficiencias primarias se caracterizan por niveles elevados de IgE e infecciones cutáneas de origen viral. Describimos el caso de un niño de 2 años y 8 meses de edad, con inmunodeficiencia combinada, dermatitis y molusco contagioso diseminado. El paciente presentaba niveles aumentados de IgE, eosinofilia y marcada linfopenia a predominio de TCD8. Se encontraron alteraciones en los ensayos funcionales por cultivo y en la respuesta a la vacunación. Resultados normales de la proteína ZAP-70, funcionalidad NK y niveles de HLA I, tendientes a verificar alteraciones cuantitativas y funcionales de las células citotóxicas, llevaron a la sospecha de deficiencia en el gen DOCK8. El resultado positivo del estudio molecular, junto con las características clínicas e inmunológicas del paciente, confirmaron el diagnóstico de esta nueva inmunodeficiencia, que, de acuerdo con nuestro conocimiento, sería el primer caso diagnosticado en un hospital pediátrico en nuestro país.

Different primary immunodeficiencies present increased levels of IgE and cutaneous infections of viral etiology. We report a case of a 2 y, 8 m old boy with combined immunodeficiency, dermatitis and disseminated molluscum contagiosum. The patient presented high titers of IgE, eosinophilia and pronounced TCD8 lymphopenia. Impaired proliferation assays and abnormal antibody response to vaccination were found. Normal results of ZAP-70 protein, NK function, and HLA I levels, to test quantitatives and functional defects of cytotoxic cells, lead us to suspect a mutation in DOCK8 gene. Positive result in molecular study together with clinical and immunology features in the patient confirmed the diagnosis of this new immunodeficiency, being to the authors ́ knowledge the first case recorded in a paediatric hospital in our country.