El sistema inmune en los linfedemas y linfangitis de los miembros inferiores / The immune system in lymphedema and lymphangitis of the lower limbs

El sistema inmune es el mecanismo de resistencia del organismo ante las infecciones. El sistema linfático juega un importante papel en el control fisiológico del fluido tisular y en la iniciación de la respuesta inmune. Nos proponemos describir la función de los componentes celulares del sistema inmune en las linfopatías de miembros inferiores no asociadas a cánceres tales como el linfedema y la linfangitis.Se revisaron las bases de datos PubMed, MedLine, SciELO, Clinical Key, Liliacs, Ebsco y artículos científicos publicados en revistas cubanas entre 2000-2015. Los estudios recientes muestran que el crecimiento de nuevos vasos linfáticos es una característica distintiva de las reacciones inflamatorias agudas y crónicas que caracterizan a las linfopatías, mediado por un incremento en el drenaje del fluido fuera del vaso y de células inflamatorias, así como de la modulación de las respuestas inmunes. Es apremiante continuar investigando, específicamente en lo concerniente al comportamiento de la inmunidad humoral y celular en los pacientes que padecen de linfedema o linfangitis, pues no se encontraron trabajos que aborden de manera específica la posible relación entre ambos. Se sugiere que las subpoblaciones de células T son un componente crítico en la respuesta celular inflamatoria crónica y subaguda en las linfopatías. La comprensión de la función reguladora del fluido linfático en la respuesta inflamatoria puede dar un importante paso en el desarrollo de tratamientos que puedan bloquear el inicio o la progresión de las consecuencias anómalas de las lesiones linfáticas(AU)

The immune system is the body´s mechanism of resistance to infections. The lymph system plays an important role in the physiological control of the tissue fluid and in the onset of the immune response. We intended to describe the function of the cell components of the immune system in the cancer-unrelated lymphopathies of the lower limbs such as lymphedema and lymphangitis. To this end, Pubmed, Medline, Scielo, Clinical Key, Liliacs, Ebsco and scientific articles published in Cuban medical journals from 2000 to 2015 were reviewed. The recent studies show that the growth of new lymphatic vessels is a distinctive characteristic of the acute and chronic inflammatory reactions of lymphopathies, mediated by increase of the fluid drainage outside the vessel and of inflammatory cells as well as the immune response modulations. It is urgent to continue studying this topic, mainly the behavior of the humoral and cell immunity in patients suffering from lymphedema or lymphangitis, since no research papers dealing with the possible relation between both aspects were found. It is suggested that the T-cell subpopulations are a key component of the chronic and sub-acute inflammatory response in lymphopaties. Hence, understanding of the regulating function of the lymph fluid in the inflammatory response may represent an important step in the development of therapies that might block the onset or progression of the anomalous consequences of lymphatic injures(AU)

Paracoccidioidomycosis: acute-subacute clinical form, juvenile type.

The authors report aspects of paracoccidioidomycosis, acute-subacute clinical form, juvenile type, in a 19-year-old female patient. Paracoccidioidomycosis, juvenile type, classically occurs in young patients, both sexes, with lymphoma-like aspects as initial presentation. However, following the natural history of the disease the lymph nodes assume patterns of infectious disease, as an abscess and fistulae. Systemic dissemination of the disease can occur and lethality and morbidity are significant in this clinical presentation.

Paracoccidioidomycosis: acute-subacute clinical form, juvenile type

Abstract: The authors report aspects of paracoccidioidomycosis, acute-subacute clinical form, juvenile type, in a 19-year-old female patient. Paracoccidioidomycosis, juvenile type, classically occurs in young patients, both sexes, with lymphoma-like aspects as initial presentation. However, following the natural history of the disease the lymph nodes assume patterns of infectious disease, as an abscess and fistulae. Systemic dissemination of the disease can occur and lethality and morbidity are significant in this clinical presentation.

Linfangitis flictenular en una embarazada / Flictenular Linfangitis in Pregnancy

La linfangitis es un fenómeno inflamatorio de los vasos linfáticos en cualquier sector del sistema linfático. Producida por agentes biológicos, los más frecuentes Staphylococcus y Streptococcus pyogenes. El diagnóstico se realizó en el Servicio de Cuidados Intensivos Perinatales del Hospital Lenin de Holguín, en una paciente saludable de 20 años, procedente del municipio Urbano Noris, con un embarazo de 29,4 semanas, tenía el antecedente de un traumatismo pequeño en un pie hacia 48 h, iniciando con toma del estado general, fiebre de 38,5 grados Celsius, dolor en el pie, acompañado de enrojecimiento y aparición de vesícula que aumentaron de tamaño rápidamente alcanzando de 5 a 6 cm, con una evolución desfavorable que la llevó a ingreso en Unidad de Cuidados Intensivos del Hospital Lenin, Holguín por una sepsis grave, fue necesario durante su evolución tratamiento antimicrobianos y quirúrgico junto a la aplicación de derivados hemáticos (plaquetas lisadas), lo que permitió conservar su miembro inferior y llegar al término de la gestación con un recién nacido de buen peso.(AU)

Lymphangitis is a disease known since Hippocrates time, is an inflammatory phenomenon of lymphatic vessels in any sector of the vascular system. The etiology of this acute disease is diverse, with those caused by biological agents the most connotation, and among them those caused by Staphylococcus and Streptococcus pyogenes. The diagnosis was made in a healthy 20 year- old pregnant patient (29.4 weeks of gestation). The patient had a history of a small injury on one foot during 48 hours. The general state of the patient was bad and began with fever of 38.5 degrees Celsius, foot pain accompanied by redness and increased occurrence of vesicle size quickly reaching 5-6 cm, with an unfavorable evolution that led to admission to Intensive Care Unit of Lenin, Holguin Hospital for severe sepsis. Antibiotics and surgical treatments with the use of blood products were necessary, for a satisfactory evolution, allowing to preserve the lower limb and reach the end of gestation with a newborn good weight.

Eccrine porocarcinoma with carcinomatous lymphangitis in a patient with history of arsenic exposure: a case report.

Eccrine porocarcinoma is a potentially fatal form of sweat gland carcinoma, due to its propensity to metastasize through lymph vessels. The authors report the case of a 69-year-old female who presented with swelling of the right leg and an ulcerated lesion of the right great toe. The initial histologic diagnosis was invasive squamous cell carcinoma. On follow-up, the patient developed lymphangitic tumor spread in the right leg, associated with right inguinal lymphadenopathy and lesions in vulva and flank. Reevaluation of the toe lesion led to a revised diagnosis of eccrine porocarcinoma. The patient also had 2 basal cell carcinomas of the multicentric/superficial type in the skin overlying the left breast. Past history included chronic ingestion of liquore arsenic (Fowler's solution) in early adulthood as treatment for dermatitis herpetiformis.

Infecções por Corynebacterium pseudotuberculosis em animais de produção / Cornebacterium pseudotuberculosis infection production animals / Una Forma Rara De Ocurrencia De Schistosomus Reflexus En Vacuno – Relato Del Caso

As infecções por Corynebacterium pseudotuberculosis são caracterizadas por processos piogranulomatosos crônicos em várias espécies de animais de produção. Nos equinos,bovinos e pequenos ruminantes a infecção por este actinomiceto causa abscesso peitoral ou “peito de pombo”, linfangite ulcerativa e linfadenite caseosa, respectivamente. O presente estudo procura revisar os principais aspectos da infecção por C. pseudotuberculosis em ruminantes domésticos e equinos, com ênfase nos fatores de virulência, epidemiologia, manifestações clínicas, métodos de diagnósticos, controle, profilaxia e reflexos na saúde pública.

Corynebacterium pseudotuberculosis infections are characterized by chronic pyogranulotous process in several domestic animals. In equine, bovine and small ruminants the affection by this actinomycete lead to pectoral abscesses, ulcerative limphangites and caseous lymphadenitis, respectively. The present study reviewed the most-important aspects of C. psedotuberculosis infectons, in domestic ruminants and equines, with emphasis for virulence factors of microorganism, epidemiology, clinical manifestations, methods of diagnosis, control aspects and impact in public health of bacteria.

El Schistosomus reflexus (SR) es una anomalía congénita fatal y rara, que se encuentra principalmente en rumiantes, gestando un feto con plegado de la columna vertebral, la exposición de las vísceras abdominales y torácicas, anquilosis de las extremidades, hipoplasia hepática y diafragmática, escoliosis y anomalías del sistemas digestivo y genitourinario. Fue llevado al Hospital Veterinario, FMVZ - UNESP - Botucatu /SP, una aberración congénita deforme removida por tracción forzada en la distocia de vaca mestiza perteneciente a un ganadero en la ciudad de Lençóis Paulista /SP. Por las características generales y resultados de la necropsia fue posible concluir que este es un caso raro de SR, no hay informes sobre casos similares de esta malformación totalmente cubiertos por la epidermis y dermis.

Infecções por Corynebacterium pseudotuberculosis em animais de produção / Cornebacterium pseudotuberculosis infection production animals / Una Forma Rara De Ocurrencia De Schistosomus Reflexus En Vacuno Relato Del Caso

As infecções por Corynebacterium pseudotuberculosis são caracterizadas por processos piogranulomatosos crônicos em várias espécies de animais de produção. Nos equinos,bovinos e pequenos ruminantes a infecção por este actinomiceto causa abscesso peitoral ou “peito de pombo”, linfangite ulcerativa e linfadenite caseosa, respectivamente. O presente estudo procura revisar os principais aspectos da infecção por C. pseudotuberculosis em ruminantes domésticos e equinos, com ênfase nos fatores de virulência, epidemiologia, manifestações clínicas, métodos de diagnósticos, controle, profilaxia e reflexos na saúde pública.(AU)

Corynebacterium pseudotuberculosis infections are characterized by chronic pyogranulotous process in several domestic animals. In equine, bovine and small ruminants the affection by this actinomycete lead to pectoral abscesses, ulcerative limphangites and caseous lymphadenitis, respectively. The present study reviewed the most-important aspects of C. psedotuberculosis infectons, in domestic ruminants and equines, with emphasis for virulence factors of microorganism, epidemiology, clinical manifestations, methods of diagnosis, control aspects and impact in public health of bacteria.(AU)

El Schistosomus reflexus (SR) es una anomalía congénita fatal y rara, que se encuentra principalmente en rumiantes, gestando un feto con plegado de la columna vertebral, la exposición de las vísceras abdominales y torácicas, anquilosis de las extremidades, hipoplasia hepática y diafragmática, escoliosis y anomalías del sistemas digestivo y genitourinario. Fue llevado al Hospital Veterinario, FMVZ - UNESP - Botucatu /SP, una aberración congénita deforme removida por tracción forzada en la distocia de vaca mestiza perteneciente a un ganadero en la ciudad de Lençóis Paulista /SP. Por las características generales y resultados de la necropsia fue posible concluir que este es un caso raro de SR, no hay informes sobre casos similares de esta malformación totalmente cubiertos por la epidermis y dermis. (AU)

Carcinomatous lymphangitis as the initial manifestation of ovarian adenocarcinoma.

Carcinomatous lymphangitis accounts for approximately 8% of all cases of metastatic pulmonary tumors. The most common primary sites are breast, lung, stomach, prostate and pancreas. We describe herein the case of a 42-year-old woman in whom the first manifestation of an ovarian adenocarcinoma was carcinomatous lymphangitis of the lung, an unusual presentation of the disease.

Linfangite carcinomatosa pulmonar como manifestação inicial de adenocarcinoma de ovário / Carcinomatous lymphangitis as the initial manifestation of ovarian adenocarcinoma

A linfangite carcinomatosa corresponde a cerca de 8 por cento das neoplasias pulmonares metastáticas. Os sítios primários mais comuns são mama, pulmão, estômago, próstata e pâncreas. Descrevemos o caso de uma paciente de 42 anos na qual a primeira manifestação de um adenocarcinoma de ovário foi a linfangite carcinomatosa, uma forma incomum de apresentação da doença.

Carcinomatous lymphangitis accounts for approximately 8 percent of all cases of metastatic pulmonary tumors. The most common primary sites are breast, lung, stomach, prostate and pancreas. We describe herein the case of a 42-year-old woman in whom the first manifestation of an ovarian adenocarcinoma was carcinomatous lymphangitis of the lung, an unusual presentation of the disease.

Simultaneous occurrence of pulmonary tuberculosis and carcinomatous lymphangitis.

Tuberculosis is an important cause of mortality due to its high prevalence, considering that one third of the worlds population is infected with the tuberculosis bacillus. We report the first case of carcinomatous lymphangitis associated with active pulmonary tuberculosis. Carcinomatous lymphangitis is a rare event that may be confounded with tuberculosis because of its radiographic and clinical characteristics.

Simultaneous occurrence of pulmonary tuberculosis and carcinomatous lymphangitis

Tuberculosis is an important cause of mortality due to its high prevalence, considering that one third of the worldÆs population is infected with the tuberculosis bacillus. We report the first case of carcinomatous lymphangitis associated with active pulmonary tuberculosis. Carcinomatous lymphangitis is a rare event that may be confounded with tuberculosis because of its radiographic and clinical characteristics.

Tuberculose é uma causa importante de mortalidade devido a sua alta prevalência, uma vez que um terço da população mundial encontra-se infectada com o bacilo da tuberculose. Nós relatamos o primeiro caso de linfangite carcinomatosa associada à tuberculose pulmonar ativa. A linfangite carcinomatosa é um evento raro que pode ser confundida com tuberculose pelos aspectos clínicos e radiológicos.

Seasonal fluctuations of incubation, healing delays, and clinical presentation of cutaneous leishmaniasis in French Guiana.

An investigation was conducted to determine whether seasonal variations affected the development of cutaneous leishmaniasis. Data from 499 cases treated between July 1994 and December 1998 were analyzed. The interval between infection and consultation and between treatment and clinical cure varied significantly between cases with an incubation period during the dry season compared with the rainy season (P < 0.001). When the incubation period occurred during the dry season, the standard pentamidine isethionate treatment seemed to be less effective (i.e.. the odds ratio for failure was 1.9 [1.1-3.4], P = 0.01). The presence of lymphangitis was more frequent during the dry season (i.e., the odds ratio was 0.26 [0.15-0.45], P < 0.001). These results suggested that the observed seasonal variations were due to variations in the host/parasite balance. Converging indirect elements that suggest a role for variations in solar ultraviolet radiation are discussed.

[Pulmonary mucormycosis infection in a boy with AIDS]. / Infección por mucormicosis pulmonar en un niño con SIDA.

It is described a pulmonary mucormycosis in an 11-year-old child with AIDS. The diagnosis was obtained by direct examination of the bronchial aspiration. The non-septate, hyaline, dichotomous, pathognomonic cenotic hyphae of this disease were observed. The child was cured with the specific treatment with Amphotericin B, since he died a year later and this affection did not appear in the necropsy. This combination of pulmonary mucormycosis and AIDS has never been reported in Cuba.

Pulmonary tumor embolism to arterial vessels and carcinomatous lymphangitis. A comparative clinicopathological study.

A prospective study of 222 consecutive autopsies of cancer cases was undertaken to investigate whether carcinomatous lymphangitis and pure arterial tumor embolism of the lungs are different clinicopathological entities. The lungs were removed as a block and 15 sections (three from each lobe) were analyzed. A protocol containing clinical (ie, dyspnea, cyanosis, right ventricular failure, engorgement of jugular veins, and peripheral edema as main cause of death) and morphological (ie, right ventricle thickness and dilatation, vascular sclerosis, pulmonary infarct) data were carefully recorded in each case. Arterial tumor embolism was detected in 19 cases (8.5%) and carcinomatous lymphangitis in 44 cases (19.8%). We found no differences in relation to signs and symptoms of arterial tumor embolism and carcinomatous lymphangitis, but respiratory distress as the main cause of death was significantly more frequent in the cases with arterial involvement by tumor emboli. Morphologically, however, right ventricular hypertrophy-dilatation, histological signs of pulmonary hypertension, and hemorrhagic infarcts were more prevalent in the cases with arterial tumor embolism. This study permits us to conclude that although arterial tumor embolism and carcinomatous lymphangitis are clinically similar diseases, they are morphologically different entities. Our results suggest that the most probable pathogenesis of pulmonary endarteritis and subsequent pulmonary hypertension is the injury to the vascular endothelium caused by the arrest of tumor emboli.

Carcinomatosis linfangitica unilateral en cáncer de mama: reporte de um caso / Unilateral lymphangitic carcinomatosis in breast cancer: report of a case

Se reporta el caso de una mujer blanca con cáncer de mama y matástasis linfangíticas pulmonares unilaterales. Se presentan aspectos clínicos y se discuten aspectos patogénicos y etiológicos