Diagnóstico da infecção por Bartonella spp.: a propósito de um caso de angiomatose bacilar / Diagnosis of Bartonella spp. infection: study of a bacillary angiomatosis case

Várias dermatoses são consideradas idiopáticas. Muitas vezes, afecções como eritema nodoso ou eritema multiforme, por exemplo, não podem ter sua etiologia definida. A infecção humana por Bartonella spp. pode determinar várias expressões clínicas sindrômicas. A partir de um caso de angiomatose bacilar com documentação clínica, histológica e ultra-estrutural, foi feita a revisão da literatura médica para avaliar os critérios diagnósticos disponíveis para a infecção por esses agentes. Conclui-se que a avaliação histológica é, na prática, um importante e útil método diagnóstico, especialmente quando a sorologia não estiver disponível.

Several dermatoses are considered idiopathic diseases. Many times lesions such as erythema nodosum or erythema multiformis, for example, cannot have their etiology defined. Human infection caused by Bartonella spp. may determine several clinical syndromic expressions. Starting with a clinically, histologically and ultrastructurally documented bacillary angiomatosis case, a review of medical literature was undertaken to evaluate the available diagnostic criteria regarding infection caused by these agents. Histological evaluations were concluded to be, practically speaking, an important and useful diagnostic method, especially when serology is not available.

Association between psoriasis vulgaris and MHC-DRB, -DQB genes as a contribution to disease diagnosis.

We analyzed 100 control individuals and 60 patients with psoriasis vulgaris from the population of Campinas, Brazil. Typification of class II HLA alleles (HLA-DRB1-5 and -DQB1) was carried out through the DNA/PCR/SSP at medium and high resolution. DNA was extracted through a salting-out procedure: 13 DRB1 alleles, 3 DRB3 alleles, 1 DRB4 allele, 2 DRB5 alleles, and 5 DQB1 alleles were identified at a medium resolution using the PCR/SSP, and 45 DRB1 alleles were identified at a high resolution in analyzed patients. Results showed associations with psoriasis vulgaris: positive associations HLA-DRB3*02 (p < 0.05, chi(2) = 5.10, RR = 2.14); HLA-DRB1*0102 alleles (p < 0.05, RR = 5.44). Negative associations were found for HLA-DRB4*01 (chi(2) = 3.23, RR = 0.55) and HLA-DRB1*1302 alleles (p < 0.05, RR = 0.23). The haplotypes revealed positive association for HLA-DRB1*0102/DQB1*05 (p < 0.05, RR = 5.44) and HLA-DRB1*0701/DQB1*03 alleles (p < 0.02, RR = 9.00). These findings suggest a possible association of the DRB1 allele with the group of patients showing an early onset of the illness, as well as an association with haplotypes HLA-DRB1*0102/DQB1*05 and HLA-DRB1*0701/DQB1*03.

Subcutaneous and cerebral cysticercosis.

Cysticercosis is a human infestation, which is considered the most common cause of seizures worldwide. The subcutaneous lesions can help in the diagnosis of neurocysticercosis. We describe a case of a 45-year-old patient with multiple cutaneous nodules first seen 2 years ago that were increasing in number, and normal neurologic and fundoscopic examination. Neurologic symptoms started 3 months before hospital admission as a mild headache and muscular weakness. The imaging examinations showed a massive central nervous system involvement. Physicians must be aware of the importance of subcutaneous nodule examination for the diagnosis of neurocysticercosis.

What do we (not) know about the human bartonelloses?

The human bartonelloses are a group of diseases with a rapidly increasing clinical spectrum. Well known manifestations such as Carrion's disease, trench fever, cat-scratch disease, and bacillary angiomatosis are examples of Bartonella sp. infection. Along with these diseases, recurrent bacteremia, endocarditis, septicemia, erythema nodosum, erythema multiforme, trombocytopenic purpura and other syndromes have been reported having been caused by bacteria of this genus. The infectious process and the pathogenesis of these microorganisms are poorly understood. The bartonelloses may have a benign and self-limited evolution in a host, or a potentially fatal one. These bacteria can provoke a granulomatous or an angioproliferative histopathologic response. As these diseases are not yet well defined, we have reviewed the four main human bartonelloses and have examined unclear points about these emergent diseases.

What do we (not) know about the human bartonelloses?

The human bartonelloses are a group of diseases with a rapidly increasing clinical spectrum. Well known manifestations such as Carrion's disease, trench fever, cat-scratch disease, and bacillary angiomatosis are examples of Bartonella spp. infection. Along with these diseases, recurrent bacteremia, endocarditis, septicemia, erythema nodosum, erythema multiforme, trombocytopenic purpura and other syndromes have been reported having been caused by bacteria of this genus. The infectious process and the pathogenesis of these microorganisms are poorly understood. The bartonelloses may have a benign and self-limited evolution in a host, or a potentially fatal one. These bacteria can provoke a granulomatous or an angioproliferative histopathologic response. As these diseases are not yet well defined, we have reviewed the four main human bartonelloses and have examined unclear points about these emergent diseases

Ultrastructural changes in a standard strain of Bartonella henselae after passages through BALB/cAn mice.

Human bartonelloses are a group of illnesses of poorly understood pathogenesis. Bartonella henselae is one of the most studied bacterium of its genus. The objective of this study was to observe whether passages of these bacteria, in vivo, would determine ultrastructural changes in them. For this purpose, isogenic mice were inoculated with a standard strain of B. henselae (I). These were initially retrieved from genetically immunodeficient animals (II) and then inoculated in immunocompetent ones. The bacterial colonies obtained (III) were compared, by transmission electron microscopy, with colonies I and II. Loss of fimbriae and an abundant bleb formation were the most common morphological changes found in colony III. Also, on day 6 postinfection, the main histological abnormalities were the endothelial proliferation presented in immunodeficient animals and the incipient granulomata reaction found in one of the immunocompetent inoculated mice, which died spontaneously. These features agree with the Bartonella human disease clinical and histological observations. This study demonstrates that B. henselae in vivo passages induce significant morphological changes in the bacteria and that these abnormalities could explain their seemingly greater virulence. Most of these observations have not been previously described. Thus, further studies on the Bartonella species pathogenesis should consider these data.

Curativo semipermeável transparente: aplicaçäo em dermatologia / Semipermeable transparent dressing: dermatologia application

Os autores avaliaram 42 pacientes de ambos os sexos, com idade média de 39 anos, portadores de lesöes cutâneas recentes (suturadas, eleltrocoaguladas, erosadas), cobertas com o curativo transparente de poliuretano. Os curativos permaneceram de quatro a 15 dias nos pacientes, sendo trocados duas vezes em apenas três casos. Com a adaptaçäo do curativo aos contornos das áreas cutâneas lesadas, houve o favorecimento da liberdade de movimentaçäo, além da comodidade para o banho diário. Pela experiência adquirida com este tipo de curativo, os autores recomendam a sua utilizaçäo nos tipos de lesöes avaliadas

Erisipela

A erisipela, suscetível de ocorrência em qualquer faixa etária, é uma manifestaçäo de celulite superficial com intenso comprometimento do plexo linfático subjacente. A autora fornece dados importantes sobre o quadro clínico, diagnóstico diferencial, exames de laboratório, evoluçäo, prognóstico e tratamento, além dos indispensáveis cuidados tópicos

Ectima: estudo clínico-epidemiológico e laboratorial em 2377 crianças / Ecthyma: clinico-epidemiological and laboratory study in 2377 children

Estudo clínico-epidemiológico e bacteriológico de ectima, em 2.377 crianças, revelou prevalência de 12%, com predomínio no sexo masculino em relaçäo ao feminino e nos melânicos, comparados aos leucodérmicos. Sugere influência de pequenos traumatismos cutâneos e de condiçöes socioeconômicas precárias como fatores predisponentes, e a ocorrência de tipos etiológicos específicos de estafilococos e estreptococos. É valorizada a importância do tratamento precoce

Staphylococcus aureus: II. Prevalência em portadores säos e pacientes com conjuntivite estafilocócica / Staphylococcus aureus: II. Ocurrence in healthy carriers and patients with staphylococcal conjunctivitis

Quarenta e cinco amostras de Staphylococcus aureus, isoladas de doentes com conjuntivite estafilocócica e de portadores säos, foram estudadas sob os seguintes aspectos: susceptibilidade a antimicrobianos e a fagos e produçäo de coagulase. Vinte das amostras foram do modelo de antibiograma RSSS de Barber e Burston e 16 do modelo RSSR. Näo houve correlaçäo entre fagótipo e tempo para coagulaçäo do plasma. Foi observada maior frequência de amostras com fagótipos do grupo III, sendo que nenhuma das amostras isoladas de secreçäo ocular foi fagotipável

Staphylococcus aureus: prevalência de portadores extra-hospitalares (restaurante) na cidade de Ribeiräo Preto - S.P. (1981) / Staphylococcus aureus: carriers in a non-hospital community (restaurant) of Ribeiräo Preto city - Säo Paulo (1981)

No presente trabalho analisamos a freqüência de portadores extra-hospitalares de Staph. aureus em profissionais que trabalham em copa e cozinha e um restaurante junto a uma empresa particular de Ribeiräo Preto - SP. Aproximadamente 72,2% das pessoas examinadas albergavam o Staph. aureus nas várias áreas examinadas: orofaringe 2,1%, fossas nasais 50% e mäos 57,1%. Näo apresentavam lesäo aparente ou queixa de qualquer infecçäo. Estudamos também a sensibilidade a antibióticos (Modelos de Barber & Bruston) e a caracterizaçäo destas amostras pela fagotipagem, tendo sido encontrada uma prevalência da superposiçäo de grupos fágicos do Conjunto Básico Internacional, Experimentais, Extra, näo classificados, e os modelos RRSR e RRSS de Barber & Burston