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2.
Int J Mycobacteriol ; 8(2): 208-210, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31210170

RESUMEN

Hansen's disease is a chronic infectious granulomatous disease with varied clinical presentation. Histoid Hansen's disease is an important emerging lepromatous subset of Hansen's disease known to mimic varied dermatoses. Occurrence of reactions, especially erythema nodosum leprosum (ENL), is rare in this form of leprosy. We report a case of Histoid Hansen's disease with initial presentation of ENL while undergoing management for infertility.


Asunto(s)
Eritema Nudoso/diagnóstico , Eritema Nudoso/microbiología , Lepra Lepromatosa/microbiología , Lepra Multibacilar/diagnóstico , Adulto , Humanos , Leprostáticos/uso terapéutico , Lepra Lepromatosa/diagnóstico , Masculino , Piel/microbiología , Piel/patología
4.
Int J Mycobacteriol ; 7(2): 191-194, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29900900

RESUMEN

Erythema nodosum leprosum (ENL) is characterized by tender erythematous nodules, accompanied by fever, malaise, arthralgia, and systemic complications. Atypical clinical manifestations have been reported such as pustular, bullous, ulceration; livedo reticularis; erythema multiforme-like reaction; and Sweet's syndrome (SS)-like presentation. We reported a case of ENL reaction presenting as SS-like reaction in a borderline lepromatous leprosy patient.


Asunto(s)
Eritema Nudoso/diagnóstico , Lepra Dimorfa/diagnóstico , Lepra Lepromatosa/diagnóstico , Síndrome de Sweet/diagnóstico , Adulto , Eritema Nudoso/microbiología , Eritema Nudoso/patología , Humanos , Lepra Dimorfa/microbiología , Lepra Dimorfa/patología , Lepra Lepromatosa/microbiología , Lepra Lepromatosa/patología , Masculino , Mycobacterium leprae/genética , Mycobacterium leprae/aislamiento & purificación , Síndrome de Sweet/microbiología , Síndrome de Sweet/patología
5.
J Pak Med Assoc ; 68(4): 653-656, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29808061

RESUMEN

Leprosy is a chronic granulomatous disease involving the skin and nerves, leading to a debilitating condition. Leprosy has been controlled in most parts of the world; therefore physicians are not very well versed in the recognition, management and assessment of this disease. The protean manifestations of leprosy often lead to delays in diagnosis and increase the morbidity. We present a case of a 33-year-old male with fever, lymphadenopathy, nodular skin lesions, uveitis and arthritis. Lymphnode, bonemarrow and skin biopsy revealed 3+ AFB smear with negative AFB cultures, leading to the diagnosis of leprosy. The course of illness was complicated by flare of Erythema Nodosum Leprosum (ENL).


Asunto(s)
Eritema Nudoso/microbiología , Fiebre/microbiología , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/diagnóstico , Adulto , Artritis/microbiología , Enfermedad Crónica , Humanos , Linfadenopatía/microbiología , Masculino , Uveítis/microbiología
6.
An Bras Dermatol ; 93(2): 181-184, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29723371

RESUMEN

BACKGROUND: Erythema nodosum leprosum may appear before, during or after treatment of leprosy and is one of the main factors for nerve damage in patients. When it occurs or continues to occur after treatment, it may indicate disease recurrence and a new treatment may be instituted again. OBJECTIVE: To evaluate the retreatment of patients with multibacillary leprosy who underwent standard treatment with multidrug therapy, but developed or continued to present reactions of erythema nodosum leprosum and/or neuritis 3-5 years after its end. METHOD: For this objective, a new treatment was performed in 29 patients with multibacillary leprosy who maintained episodes of erythema nodosum and/or neuritis 3-5 years after conventional treatment. RESULTS: In general, we observed that 27 (93.10%) had no more new episodes after a follow up period of eight months to five years. In five of these patients the reason for the retreatment was the occurrence of difficult-to-control neuritis, and that has ceased to occur in all of them. STUDY LIMITATIONS: Small number of patients.. CONCLUSION: In the cases observed, retreatment was an effective measure to prevent the occurrence of erythema nodosum leprosum and/or persistent neuritis.


Asunto(s)
Eritema Nudoso/tratamiento farmacológico , Lepra Lepromatosa/tratamiento farmacológico , Lepra Multibacilar/tratamiento farmacológico , Neuritis/tratamiento farmacológico , Eritema Nudoso/microbiología , Femenino , Humanos , Leprostáticos/uso terapéutico , Lepra Lepromatosa/microbiología , Lepra Multibacilar/microbiología , Masculino , Neuritis/microbiología , Recurrencia , Retratamiento , Factores de Tiempo , Resultado del Tratamiento
7.
An. bras. dermatol ; 93(2): 181-184, Mar.-Apr. 2018. graf
Artículo en Inglés | LILACS | ID: biblio-887190

RESUMEN

Abstract: Background: Erythema nodosum leprosum may appear before, during or after treatment of leprosy and is one of the main factors for nerve damage in patients. When it occurs or continues to occur after treatment, it may indicate disease recurrence and a new treatment may be instituted again. Objective: To evaluate the retreatment of patients with multibacillary leprosy who underwent standard treatment with multidrug therapy, but developed or continued to present reactions of erythema nodosum leprosum and/or neuritis 3-5 years after its end. Method: For this objective, a new treatment was performed in 29 patients with multibacillary leprosy who maintained episodes of erythema nodosum and/or neuritis 3-5 years after conventional treatment. Results: In general, we observed that 27 (93.10%) had no more new episodes after a follow up period of eight months to five years. In five of these patients the reason for the retreatment was the occurrence of difficult-to-control neuritis, and that has ceased to occur in all of them. Study limitations: Small number of patients.. Conclusion: In the cases observed, retreatment was an effective measure to prevent the occurrence of erythema nodosum leprosum and/or persistent neuritis.


Asunto(s)
Humanos , Masculino , Femenino , Lepra Lepromatosa/tratamiento farmacológico , Eritema Nudoso/tratamiento farmacológico , Lepra Multibacilar/tratamiento farmacológico , Neuritis/tratamiento farmacológico , Recurrencia , Factores de Tiempo , Lepra Lepromatosa/microbiología , Resultado del Tratamiento , Retratamiento , Eritema Nudoso/microbiología , Lepra Multibacilar/microbiología , Leprostáticos/uso terapéutico , Neuritis/microbiología
8.
Infection ; 46(1): 127-129, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28819912

RESUMEN

BACKGROUND: Acute Q fever is asymptomatic in 60% of the patients, while the reminder may present with fever, pneumoniae, and hepatitis. Skin manifestations are uncommon including transient punctiform rashes, purpuric, or maculopapular eruptions. Erythema nodosum have seldom been reported. CASE PRESENTATION: A 37-year-old female presented with fever for 1 month and skin lesions consists of erythematous painful nodule of the legs. Serological testing for Coxiella burnetii was positive. Treatment consisted with doxycycline for 2 weeks. Evolution was favorable. The patient completely recovered and had no evidence of skin lesion 1 month later. CONCLUSION: Because of its nonspecific clinical presentation, Q fever with erythema nodosum is probably underestimated. Q fever should be evocated when facing unexplained erythema nodosum even if there is not other typical clinical manifestation of Q fever.


Asunto(s)
Antibacterianos/uso terapéutico , Coxiella burnetii/aislamiento & purificación , Doxiciclina/uso terapéutico , Eritema Nudoso/diagnóstico , Fiebre Q/diagnóstico , Adulto , Eritema Nudoso/tratamiento farmacológico , Eritema Nudoso/microbiología , Femenino , Humanos , Fiebre Q/complicaciones , Fiebre Q/tratamiento farmacológico , Resultado del Tratamiento
9.
Am J Dermatopathol ; 39(11): 857-859, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28763338

RESUMEN

Erythema nodosum leprosum (ENL) may uncommonly present before treatment in patients with multibacillary leprosy. Atypical manifestations are known in ENL and may be clinically misleading. Such wide variations in the clinical presentation of leprosy in reaction make histopathology an important tool for supporting clinical diagnosis. We report bullous ENL presenting as the first manifestation of leprosy in a 30-year-old Indian man diagnosed using histopathology.


Asunto(s)
Eritema Nudoso/patología , Lepra Lepromatosa/patología , Lepra Multibacilar/patología , Piel/patología , Adulto , Antibacterianos/uso terapéutico , Biopsia , Diagnóstico Diferencial , Eritema Nudoso/tratamiento farmacológico , Eritema Nudoso/microbiología , Humanos , Lepra Lepromatosa/tratamiento farmacológico , Lepra Lepromatosa/microbiología , Lepra Multibacilar/tratamiento farmacológico , Lepra Multibacilar/microbiología , Masculino , Valor Predictivo de las Pruebas , Piel/efectos de los fármacos , Piel/microbiología
10.
J Immunol Res ; 2017: 8139591, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28634591

RESUMEN

Even though infections are the most common cause of erythema nodosum (EN), only certain microorganisms take the great interest such as streptococci in knowledge. Our aim was to examine the frequency and type of infections in EN, to determine the characteristics of patients with an infectious etiology, and to discuss the role of these microbes in EN pathology in the context of their interactions with humans. Charts of 81 patients with EN who were seen between 2003 and 2017 were retrospectively reviewed. Identified etiological factors were classified into three groups: infectious, noninfectious, and idiopathic. While there were no significant demographic and clinical differences between the infectious and idiopathic groups, systemic symptoms (p = 0.034) and the number of EN lesions (p = 0.016) were significantly lower; the mean erythrocyte sedimentation rate was significantly higher (p = 0.049), but the mean aspartate aminotransferase value was significantly lower in the infectious group compared to the noninfectious group (p = 0.019). Besides streptococci, many other microbes, including the ones living on and inside us, were identified in the etiology of EN. There is a need for large-scale prospective studies involving control groups for a better understanding of the microbial immunopathology of EN.


Asunto(s)
Eritema Nudoso/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Piel/patología , Streptococcaceae/aislamiento & purificación , Infecciones Estreptocócicas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Eritema Nudoso/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infecciones del Sistema Respiratorio/microbiología , Estudios Retrospectivos , Piel/microbiología , Infecciones Estreptocócicas/microbiología , Turquia/epidemiología , Adulto Joven
11.
Am J Dermatopathol ; 39(4): 259-266, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28098596

RESUMEN

Inflammatory and subcutaneous nodules can arise in treated and untreated cases of Whipple disease (WD). The inflammatory immune reconstitution syndrome describes paradoxical clinical inflammatory worsening of a preexisting condition because of a return of immune function. Clinicopathologic examination of 4 patients with WD who presented with erythema nodosum leprosum (ENL)-like lesions and the findings of a systematic review of this phenomenon revealed that ENL-like lesions occurred in predominantly middle-aged male patients who suffered from WD, mostly on the legs. Patients showed a nonvasculitic, mostly septal panniculits with neutrophils, macrophages, and lymphocytes. Numerous bacteria-laden periodic acid-Schiff + macrophages and free bacilli were detected in the dermis, as well as subcutaneous septae and adipose lobules. These lesions occurred in both untreated and treated patients as part of inflammatory immune reconstitution syndrome. In conclusion, ENL-like lesions represent a characteristic histopathologic pattern associated with WD, which can occur in different contexts whenever there is a change in the immunological status of the patient. This change can be triggered by antimicrobial treatment, immunomodulatory and immunosuppressant therapy, or occur spontaneously, rarely.


Asunto(s)
Eritema Nudoso/microbiología , Síndrome Inflamatorio de Reconstitución Inmune/patología , Enfermedad de Whipple/patología , Eritema Nudoso/patología , Humanos , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana Edad , Enfermedad de Whipple/tratamiento farmacológico
13.
Infect Dis Poverty ; 5(1): 110, 2016 Dec 06.
Artículo en Inglés | MEDLINE | ID: mdl-27919284

RESUMEN

BACKGROUND: The predictive value of the serology to detection of IgM against the Mycobacterium leprae-derived phenolic glycolipid-I/PGL-I to identify leprosy patients who are at higher risk of developing reactions remains controversial. Whether baseline results of the ML Flow test can predict leprosy reactions was investigated among a cohort of patients enrolled in The Clinical Trial for Uniform Multidrug Therapy for Leprosy Patients in Brazil (U-MDT/CT-BR). METHODS: This was a descriptive study focusing on the main clinical manifestations of leprosy patients enrolled in the U-MDT/CT-BR from March 2007 to February 2012 at two Brazilian leprosy reference centers. For research purposes, 753 leprosy patients were categorized according to a modified Ridley-Jopling (R&J) classification and according to the development of leprosy reactions (reversal reaction/RR and erythema nodosum leprosum/ENL), and whether they had a positive or negative bacillary index/BI. RESULTS: More than half of the patients (55.5 %) reported leprosy reaction: 18.3 % (138/753) had a RR and 5.4 % (41/753) had ENL. Leprosy reactions were more frequent in the first year following diagnosis, as seen in 27 % (205/753) of patients, while 19 % (142/753) developed reactions during subsequent follow-up. Similar frequencies of leprosy reactions and other clinical manifestations were observed in paucibacillary (PB) and multibacillary (MB) leprosy patients treated with U-MDT and regular MDT (R-MDT) (P = 0.43 and P = 0.61, respectively). Compared with PB patients, leprosy reactions were significantly more frequent in MB patients with a high BI, and more patients developed RR than ENL. However, RR and neuritis were also reported in patients with a negative BI. At baseline, the highest rate of ML Flow positivity was observed in patients with a positive BI, especially those who developed ENL, followed by patients who had neuritis and RR. Among reaction-free patients, 81.9 % were ML Flow positive, however, the differences were not statistically significant compared to reactional patients (P = 0.45). CONCLUSIONS: MB and PB patients treated with R-MDT and U-MDT showed similar frequencies of RR and other clinical manifestations. Positive ML Flow tests were associated with MB leprosy and BI positivity. However, ML Flow test results at baseline showed limited sensitivity and specificity for predicting the development of leprosy reactions.


Asunto(s)
Eritema Nudoso/tratamiento farmacológico , Inmunoglobulina M/inmunología , Leprostáticos/uso terapéutico , Lepra Lepromatosa/tratamiento farmacológico , Adolescente , Adulto , Anciano , Antígenos Bacterianos/inmunología , Brasil , Niño , Estudios de Cohortes , Eritema Nudoso/microbiología , Femenino , Estudios de Seguimiento , Glucolípidos/inmunología , Humanos , Lepra Lepromatosa/microbiología , Masculino , Persona de Mediana Edad , Adulto Joven
14.
PLoS Negl Trop Dis ; 10(8): e0004955, 2016 08.
Artículo en Inglés | MEDLINE | ID: mdl-27556927

RESUMEN

Erythema Nodosum Leprosum (ENL) is an immune reaction in leprosy that aggravates the patient´s clinical condition. ENL presents systemic symptoms of an acute infectious syndrome with high leukocytosis and intense malaise clinically similar to sepsis. The treatment of ENL patients requires immunosuppression and thus needs to be early and efficient to prevent both disabilities and permanent nerve damage. Some patients experience multiple episodes of ENL and prolonged use of immunosuppressive drugs may lead to serious adverse effects. Thalidomide treatment is extremely effective at ameliorating ENL symptoms. Several mechanisms have been proposed to explain the efficacy of thalidomide in ENL, including the inhibition of TNF production. Given its teratogenicity, thalidomide is prohibitive for women of childbearing age. A rational search for molecular targets during ENL episodes is essential to better understand the disease mechanisms involved, which may also lead to the discovery of new drugs and diagnostic tests. Previous studies have demonstrated that IFN-γ and GM-CSF, involved in the induction of CD64 expression, increase during ENL. The aim of the present study was to investigate CD64 expression during ENL and whether thalidomide treatment modulated its expression. Leprosy patients were allocated to one of five groups: (1) Lepromatous leprosy, (2) Borderline leprosy, (3) Reversal reaction, (4) ENL, and (5) ENL 7 days after thalidomide treatment. The present study demonstrated that CD64 mRNA and protein were expressed in ENL lesions and that thalidomide treatment reduced CD64 expression and neutrophil infiltrates-a hallmark of ENL. We also showed that ENL blood neutrophils exclusively expressed CD64 on the cell surface and that thalidomide diminished overall expression. Patient classification based on clinical symptoms found that severe ENL presented high levels of neutrophil CD64. Collectively, these data revealed that ENL neutrophils express CD64, presumably contributing to the immunopathogenesis of the disease.


Asunto(s)
Eritema Nudoso/inmunología , Leprostáticos/uso terapéutico , Neutrófilos/efectos de los fármacos , Neutrófilos/inmunología , Receptores de IgG/genética , Talidomida/uso terapéutico , Adolescente , Adulto , Anciano , Biopsia , Eritema Nudoso/diagnóstico , Eritema Nudoso/tratamiento farmacológico , Eritema Nudoso/microbiología , Femenino , Humanos , Lepra Dimorfa/tratamiento farmacológico , Lepra Dimorfa/inmunología , Lepra Dimorfa/microbiología , Lepra Lepromatosa/tratamiento farmacológico , Lepra Lepromatosa/inmunología , Lepra Lepromatosa/microbiología , Masculino , Persona de Mediana Edad , Receptores de IgG/inmunología , Piel/microbiología , Piel/patología , Adulto Joven
15.
J Immunol ; 197(5): 1905-13, 2016 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-27474073

RESUMEN

The chronic course of lepromatous leprosy may be interrupted by acute inflammatory episodes known as erythema nodosum leprosum (ENL). Despite its being a major cause of peripheral nerve damage in leprosy patients, the immunopathogenesis of ENL remains ill-defined. Recognized by distinct families of germline-encoded pattern recognition receptors, endogenous and pathogen-derived nucleic acids are highly immunostimulatory molecules that play a major role in the host defense against infections, autoimmunity, and autoinflammation. The aim of this work was to investigate whether DNA sensing via TLR-9 constitutes a major inflammatory pathway during ENL. Flow cytometry and immunohistochemistry analysis showed significantly higher TLR-9 expression in ENL when compared with nonreactional lepromatous patients, both locally in the skin lesions and in circulating mononuclear cells. The levels of endogenous and pathogen-derived TLR-9 ligands in the circulation of ENL patients were also higher. Furthermore, PBMCs isolated from the ENL patients secreted higher levels of TNF, IL-6, and IL-1ß in response to a TLR-9 agonist than those of the nonreactional patients and healthy individuals. Finally, E6446, a TLR-9 synthetic antagonist, was able to significantly inhibit the secretion of proinflammatory cytokines by ENL PBMCs in response to Mycobacterium leprae lysate. Our data strongly indicate that DNA sensing via TLR-9 constitutes a major innate immunity pathway involved in the pathogenesis and evolution of ENL. Thus, the use of TLR-9 antagonists emerges as a potential alternative to more effectively treat ENL aiming to prevent the development of nerve injuries and deformities in leprosy.


Asunto(s)
ADN/metabolismo , Eritema Nudoso/inmunología , Inmunidad Innata , Lepra Lepromatosa/inmunología , Transducción de Señal , Receptor Toll-Like 9/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Eritema Nudoso/microbiología , Femenino , Citometría de Flujo , Humanos , Lepra Lepromatosa/microbiología , Leucocitos Mononucleares/inmunología , Leucocitos Mononucleares/microbiología , Masculino , Persona de Mediana Edad , Mycobacterium leprae/química , Mycobacterium leprae/inmunología , Receptor Toll-Like 9/inmunología , Adulto Joven
16.
Arch Pediatr ; 23(7): 727-30, 2016 Jul.
Artículo en Francés | MEDLINE | ID: mdl-27266640

RESUMEN

UNLABELLED: Erythema nodosum (EN) is the most common clinical and pathological variant of panniculitis. A Celsus kerion is an inflammatory and suppurative tinea of the scalp. We report on a rare case of EN secondary to a kerion of the scalp. OBSERVATION: A 9-year-old child without a notable medical history, had a squamous plaque of the vertex for 15 days, which became painful and purulent. Five days after the plaque appeared, he presented with painful, hot, erythematous lesions symmetrically on the extensor surfaces of the legs and forearms. A medical examination found a fever of 38.5°C, a squamous purulent and crusty plate of the vertex (6/5cm) with pustules and a few hairs cut short, and symmetrical painful erythematous hot nodules on the anterior surfaces of the two legs and forearms. A mycological sample of the crusts of the scalp lesion confirmed the presence of Trichophyton mentagrophytes. A bacteriological sample was not taken, and a skin biopsy confirmed the diagnosis of EN. The results of other paraclinical investigations were normal. The diagnosis of EN secondary to an inflammatory scalp tinea was established, and our patient was prescribed an orally and locally administered antimycotic, rest, and elevation of the limbs. DISCUSSION: EN is an acute nodular hypodermitis considered a nonspecific hypersensitive reaction to various allergens. Rarely, it can occur secondary to a fungal infection of the scalp such as a kerion or even secondary to the antifungal treatment of this tinea. EN secondary to a kerion of the scalp before the beginning of antifungal treatment has been reported in the literature, with a spontaneous improvement of the EN after treatment of the tinea.


Asunto(s)
Eritema Nudoso/microbiología , Tiña del Cuero Cabelludo/complicaciones , Niño , Humanos , Masculino , Trichophyton/aislamiento & purificación
17.
Indian J Lepr ; 87(1): 23-6, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26591847

RESUMEN

Lepra reactions are acute episodes occurring during the disease process of leprosy and are of 2 types: type 1 or reversal reaction and type 2 reaction or erythema odosumleprosum (ENL). In the episodes of lepra reaction several parts are affected including face and extremities like oral cavity. In the present case report we reported a rare case of lepromatous leprosy with necrotic ENL involving scalp apart from the usual sites. A 58 year old married male presented to us with complaints of spontaneous onset, recurrent eruption of multiple reddish raised painful lesions. Biopsy from the infiltrated skin over the back showed atrophic epidermis, free Grenz zone, diffuse and periadnexal macrophage granulomas with predominant mononuclear infiltrate, appandageal atrophy, fibrosis around the neural structures and leukocytoclastic vasculitis. Fites stain showed strong positivity for M. leprae. His routine blood investigations showed anemia (Hb = 7.8 gm%), neutrophil leukocytosis (TLC = 17,600, DLC = P66L28M4E2) and raised ESR (80 mm in the first hour). These bullous and necrotic lesions in leprosy may be a manifestation of severe type II reactions in patients with very high bacillary load.


Asunto(s)
Eritema Nudoso/etiología , Lepra Lepromatosa/complicaciones , Eritema Nudoso/inmunología , Eritema Nudoso/microbiología , Eritema Nudoso/patología , Humanos , Lepra Lepromatosa/microbiología , Masculino , Persona de Mediana Edad , Mycobacterium leprae/aislamiento & purificación , Mycobacterium leprae/fisiología , Necrosis , Cuero Cabelludo/microbiología , Cuero Cabelludo/patología
18.
Int J Dermatol ; 54(1): e33-7, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25208535

RESUMEN

BACKGROUND: Tularemia is a serious and potentially life-threatening zoonosis caused by Francisella tularensis, a highly infective, gram-negative coccobacillus. Although there are plenty of case reports and studies of tularemia outbreaks, the literature is lacking in reports on dermatologic manifestations of the disease. OBJECTIVES: This study aimed to identify skin manifestations in clinical forms of tularemia. METHODS: A total of 151 patients diagnosed with tularemia at Çankiri State Hospital, Çankiri, Turkey, were retrospectively examined. Dermatologic data for these patients were assessed. RESULTS: The most frequent clinical manifestation of tularemia was the glandular form (49.7%), followed by the oropharyngeal, ulceroglandular, and oculoglandular forms (39.1, 6.0, and 5.3%, respectively). Physical manifestations were observed in 64.5% of females and 56.9% of males. Lymphadenopathy and tonsillitis were the most frequent physical findings and were noted in 57.6 and 25.2% of patients, respectively. Erythema multiforme was found in 17 patients (11.3%), most of whom presented with the oropharyngeal and glandular forms, and was followed by ulcer (6.0%), urticaria (3.3%), erythema nodosum (2.6%), and cellulitis (0.7%). However, it should be noted that this study was retrospective and that its patient sample demonstrated four of the six clinical forms of tularemia. CONCLUSIONS: Patients with the oropharyngeal form of tularemia had statistically significantly more physical findings than those with other clinical forms of the disease (P < 0.001). There were statistically more skin findings in the ulceroglandular form (P < 0.001). There was no statistical correlation between serum antibody titers and cutaneous findings (P = 0.585). Although the literature reports that skin lesions are observed more frequently in women than in men, we did not find any statistically significant difference between the sexes in any type of skin lesion.


Asunto(s)
Enfermedades Cutáneas Bacterianas/microbiología , Tularemia/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Eritema Multiforme/microbiología , Eritema Nudoso/microbiología , Oftalmopatías/microbiología , Femenino , Humanos , Enfermedades Linfáticas/microbiología , Masculino , Persona de Mediana Edad , Orofaringe , Úlcera Cutánea/microbiología , Tularemia/tratamiento farmacológico , Turquia , Adulto Joven
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