Efectos colaterales de antibacilares en pacientes con enfermedad de Hansen / No disponible

Introducción: La Organización Mundial de la Salud (OMS) recomendó el uso de la poliquimioterapia (PQT) desde 1981, y desde 1998 esta pauta de tratamiento fue introducida en Paraguay. Desde ese entonces y hasta la actualidad el esquema Multibacilar (MB) comprende tres drogas: rifampicina, clofazimina y dapsona, y, el esquema Paucibacilar (PB), dos drogas: rifampicina y dapsona. Todas ellas relacionadas en mayor o menor medida a efectos colaterales. A pesar de ello, hay pocos estudios a nivel mundial, y ningún estudio en el Paraguay. Métodos: Estudio retrospectivo, observacional, de corte transversal con componente analítico, llevado a cabo en la Cátedra de Dermatología del Hospital de Clínicas - Universidad Nacional de Asunción, en San Lorenzo, Paraguay. En el periodo de enero de 2013 a octubre de 2017. Resultados: Fueron incluidos en el estudio 58 pacientes con enfermedad de Hansen, de los cuales 45 (78%) presentaron al menos un efecto colateral a la PQT, 3 pacientes presentaron más de un efecto colateral. De los 45, 25 (56%) fueron del sexo masculino y 20 (44%) del sexo femenino. En cuanto a la distribución por rango de edad: Dos (4%) en menores de 18 años, 8 (18%) de 19 a 30 años, 27 (18%) de 31 a 59 años y 8 (18%) 60 y más años. Seis (3%) pacientes de procedencia rural y 39 (87%) de procedencia urbana. Cuarenta y siete (98%) casos de efectos colaterales hematológicos (Anemia: 45; leucopenia: 1 y trombocitopenia: 1) y 1 (2%) caso de efecto colateral gastrointestinal (hepatitis). La conducta en casos de anemia: suplementación con hierro y ácido fólico: 40, suspensión de dapsona: 10 y ninguna conducta: 6 suspensión de la dapsona en 1 caso de leucopenia, suspensión de la dapsona en 1 caso de trombocitopenia y suspensión de la rifampicina en 1 caso de hepatitis. En 26 (58%) pacientes los efectos colaterales se presentaron al mes del inicio de la PQT, en 15 (33%) pacientes entre 2 y 5 meses del inicio y en 4 (9%) pacientes a los 6 y más meses del inicio. En 14 (31%) de los pacientes con efectos colaterales existía comorbilidad y en 31 (69%) casos, eran pacientes sanos. De los 45 pacientes, 41 (91%) estaban en tratamiento MB, 4 (9%) en tratamiento PB. Conclusión: La mayoría de los pacientes incluidos en el estudio presentaron efectos colaterales. Los hombres fueron los más afectados, el rango etario en el cual se presentaron con mayor frecuencia fue entre los 31 y 59 años. La mayoría procedían del medio urbano. Los efectos colaterales más frecuentes fueron los hematológicos y, de entre ellos, la anemia. Ante tal situación la medida más frecuentemente adoptada fue la suplementación con hierro y ácido fólico. En la mayoría de los casos los efectos colaterales aparecieron en el primer mes de recibir la medicación. Aquellos pacientes que recibieron PQT MB presentaron la mayor frecuencia de efectos colaterales

Introduction: The World Health Organization (WHO) recommends the implementation of multidrug (MDT) since 1981, and this régimen was introduced in Paraguay in 1998. The MDT administrate three drugs: rifampicin, clofazimine and dapsone to multibacillary patients (MB) and only two: rifampicina and dapsone to paucibacillary patients (PB). All the drugs have some adverse effects. But very few statistics have been carried out in the world on this matter and none at all in Paraguay. Methods: The work is a retrospective, observational, cross-sectional and analytical study carried out at Catedra de Dermatología del Hospital de Clínicas-Universidad Nacional de Asunción, San Lorenzo, Paraguay between January 2013 and October 2017. Results: Fifty eight leprosy patients were registered in the study and 45 (78%) presented at least one adverse effect to the MDT and 3 patients presented more tan one. 25/45 were men and 20 (44%) women. The age distributions were: Two (4%) less than 18 years old, 8 (18%) between 19-30 years old, 27(18%) 31-59 years old and 8 (18%) 60 and older. Six (3%) lived in rural setting and 39 (87%) urban. Forty seven (98%) presented adverse hematological effects (anemia: 45, leucopenia: 1 and thrombocytopenia:1) and 1 (2%) presented a gastrointestinal effect. Forty patients with anemia received iron and folic acid supplements and 6 cases with no modifications. There was 1 case leucopenia, 1 thrombocytopenia, and 1 hepatitis due to rifampicine. In 26 patients (58%) adverse effects were detected during first month of MDT, in 15 (33%) between 2-5 of treatment and in 4 (9%) patients after 6 or more months of treatment. Fourteen (31%) patients had comorbility and 31 (69%) were healthy patients. Forty one (91%) patients were receiving MB MDT and 4 (9%) PB MDT. Conclusions: The mayority of the patients in the study presented adverse effects. Men were the most affected and the mayority were in the 31-59 years age group and from urban settings. Most of the effects were hematological and among them, anemia the most frequent. These cases were supplemented with iron and folic acid. Most adverse effects appeared during the first month of treatment and MB MDT group was the most affected

Vasculitis sistémicas con compromiso cutáneo, en la Cátedra de Dermatología, Facultad de Ciencias Médicas, Universidad Nacional de Asunción / Systemic vasculitis with cutaneous involvement, in the Department of Dermatology, Faculty of Medical Sciences, National University of Asuncion

Introducción: La vasculitis sistémica presenta afectación múltiple y variada de órganos; abarca desde procesos benignos hasta mortales. Sus manifestaciones clínicas, tratamiento y pronóstico dependerán del vaso involucrado, y de la extensión y localización de la lesión. Objetivo: Determinar características epidemiológicas, clínicas, e histopatológicas, y el tratamiento de las vasculitis sistémicas con manifestaciones cutáneas en la Cátedra de Dermatología del Hospital de Clínicas, FCM - UNA. Material y método: estudio descriptivo, observacional, retrospectivo, de cohorte transversal, con componente analítico, de enero de 2004 a diciembre de 2015. Se confeccionó una planilla para registrar las variables obtenidas de fichas clínicas e histopatológicas. Resultados: Se hallaron 11 pacientes con vasculitis sistémica con afectación cutánea, (0,0098% de las consultas). Predominó el sexo masculino (63,63%). La edad media fue 30,18 años. El 18,18% eran niños todos masculinos. La lesión elemental más frecuente fue la pápula (72,72%), la localización predominante, miembros inferiores (72,72%). Los síntomas más frecuentes fueron dolor abdominal (63,63%) y la artralgia (54,54%). El 81,81% correspondía a vasculitis de vasos pequeños. En 72,72%, el componente inflamatorio eran neutrófilos. El 72,72% correspondía a Púrpura de Shönlein - Henoch (PSH), el 18,18% a Poliangeitis Microscópica (PAM), y el 9,09% a Granulomatosis con Poliangeitis (GPA). En el 72,72%, el tratamiento fue Prednisona. Conclusión: Dado que esta patología es poco frecuente, con escasos trabajos que hayan estudiado su epidemiología, este trabajo, con sus limitaciones, podría aportar para futuros estudios.

Introduction: Systemic vasculitis has multiple and varied organ involvement; Ranging from benign to deadly. Its clinical manifestations, treatment and prognosis will depend on the vessel involved, and on the extent and location of the lesion. Objectives: To determine epidemiological, clinical, and histopathological characteristics, and the treatment of systemic vasculitis with cutaneous manifestations in the Department of Dermatology Hospital of Clinics, FCM-UNA. Materials and Methods: A descriptive, observational, retrospective, cross-sectional study with an analytical component from January 2004 to December 2015. A spreadsheet was drawn up to record the variables obtained from clinical and histopathological records. Results: We found 11 patients with systemic vasculitis with cutaneous involvement, (0,0098% of the consultations). The male sex predominated (63,63%). The mean age was 30.18 years. 18,18% were children, all of them male. The most frequent elemental lesion was the papule (72,72%), the predominant location, lower limbs (72,72%). The most frequent symptoms were abdominal pain (63,63%) and arthralgia (54,54%). The 81.81% corresponded to vasculitis of small vessels. In 72,72%, the inflammatory component was neutrophils. 72,72% corresponded to Shönlein-Henoch purpura (PSH), 18,18% to Microscopic Polyangeitis (PAM), and 9,09% to Granulomatosis with Polyangeitis (GPA). In 72,72%, the treatment was Prednisone. Conclusion: Since this pathology is infrequent, with few studies that have studied its epidemiology, this work, with its limitations, could contribute for future studies.

Reacciones vasculonecróticas en la lepra. Descripción de dos casos de fenómeno de Lucio / Vasculonecrotic reactions in leprosy. Two cases of Lucio’s phenomenon

El Fenómeno de Lucio (FL), probablemente mediado por inmunocomplejos, se caracteriza por una reacción cutánea necrosante grave que ocurre en pacientes portadores de Lepra no nodular[1]. La literatura revisada muestra inadecuado uso de esta definición. Muchos autores identifican como Fenómeno de Lucio las reacciones vasculonecróticas que ocurren en formas distintas a la Lepra difusa [2, 9]. Presentamos dos casos clínicos de pacientes con formas difusas de Enfermedad de Hansen que desarrollaron fenómenos vasculonecróticos (AU)

The Lucio’s phenomenon (LP), probably mediated by immune complexes, is a severe necrotizing skin reaction that occurs mainly in patients with non nodular lepromatous leprosy. The literature review shows that there is an inadequate use of this definition. Several authors identify as LP the vasculonecrotic reactions that occur in other forms than the diffuse leprosy. We present two cases of patients with Hansen’s disease, who developed vasculonecrotic reactions (AU)

Feline calicivirus VP2 is involved in the self-assembly of the capsid protein into virus-like particles.

Feline calicivirus (FCV) is considered the most common upper respiratory tract disease (URTD) associated pathogen in cats. We previously expressed FCV VP1 capsid protein in insect cells by baculovirus system and we observed that this protein self-assemble into virus-like particles (VLPs) different in size and lacking the typical cup-like depressions of caliciviruses. In the present study, VP1 and the small basic structural protein VP2 of FCV were individually expressed by baculovirus system. Coinfection of insect cells with both recombinant viruses resulted in VP1 and VP2 self-assembly to form depressions similar to native capsids in size and appearance, demonstrating that VP2 interacts with the VP1 protein in the formation of VLPs.

Etiological investigation of multiple respiratory infections in cats.

In order to evaluate the relevance of multiple infections in domestic cats with Upper Respiratory Tract Disease (URTD) one hundred animals with clinical signs were investigated for detection of Feline Herpesvirus type-1 (FHV-1), Chlamydophila felis, Feline Calicivirus (FCV) and Bordetella bronchiseptica from mucosal swabs. Forty-seven cats were positive for FCV, 42 cats for FHV-1, 26 for B. bronchiseptica and 8 for C. felis. Dual or multiple infections were found in 33 of examined animals. Our results document that FCV and FHV-1 are the major recognized cause of URTD, although infections associated with other pathogens such as B. bronchiseptica or C. felis are also common in cats.

Diagnosis of ovine chlamydial abortions by PCR-RFLP performed on vaginal swabs.

Ovine enzootic abortion is an infectious and contagious disease clinically characterized by abortion and weak neonates, affecting sheep and goats. The etiological agent is Chlamydophila (C.) abortus, which is considered one of the most common animal pathogens of small ruminants; it has important economic implications and represents a significant zoonotic risk. Clinical diagnosis is often difficult because the clinical signs and the pathological lesions are not specific for C. abortus infection, in fact they can also be observed as a result of infections with other abortifacient agents. Moreover, the involvement of the laboratory is necessary to perform the definitive diagnosis. One hundred and seventeen vaginal swabs from sheep with clinical signs related to chlamydial infection were examined by a PCR-RFLP assay that demonstrated high specifity and sensitivity. Six samples were positive for C. abortus. Vaginal swabs are easy to handle and allow to deal with biohazardous material in safety conditions.

Use of a duplex-PCR assay to screen for Feline Herpesvirus-1 and Chlamydophila spp. in mucosal swabs from cats.

Fifty-four ocular and forty-six pharyngeal swabs, collected from 54 cats with respiratory syndrome, were analyzed by duplex-PCR to evaluate the presence of Feline Herpesvirus type 1 and Chlamydophila spp. Both pathogens are in the population of cats and as four cats were positive only in ocular swabs and three only in pharyngeal ones, it is deduced that a correct diagnostic approach has to foresee the dispatch to the laboratory of both swabs. Furthermore, all chlamydophila strains analysed by endonuclease restriction were classified as Chlamydophila felis.