Rinoplastia secundaria: infección nasal en el postoperatorio / Secondary rhinoplasty: postoperative nasal infection

La rinoplastia es una de las intervenciones más comunes en cirugía plástica. Se opera aquí una rinoplastia secundaria por vía abierta injertando los alares y la punta con cartílagos auriculares, mientras el tabique cartilaginoso fue usado para los spreader grafts. Se describe aquí una infección posoperatoria de su punta nasal. Al 9no día de su posoperatorio comienza con la punta nasal congestiva y levemente inflamada. Se medica con una crema con antibióticos, pero el día 14 aparece con la punta nasal muy inflamada y con colección. Cuando en el consultorio el cirujano la ve, como cualquier absceso, decide realizarle drenaje con un trocar 18G, 3 miniincisiones en la piel debajo de la punta nasal, de la que drena un líquido amarronado. Luego con el mismo trocar se realiza un lavado dentro de la cavidad con rifampicina solución. Se medica con trimetoprima-sulfametoxazol (Bactrimforte®) 2 comp/día. Al otro día se observa una notable mejoría. Se continuó con lavado diario durante 4 días con el mismo antibiótico evolucionando rápidamente bien. El Bactrim se lo continúa por 20 días. Al mes la punta nasal está muy bien, deshinchada con cicatrices apenas visibles. A los cuatro meses, la punta está muy blanda, las alas nasales y las narinas normales, la punta con buena proyección igual que el dorso con los spreader graft.

Rhinoplasty is one of the most common interventions in plastic surgery. A secondary open rhinoplasty was carried out grafting the allae and the tip of the nose with conchae cartilage, while the septum was used for spreader grafts. We are here describing this post operatory with a tip of the nose infection.In the control, at the 9th postoperative day, the nasal tip began to be congested and at the 14th post op day the patient showed a clear inflammatory collection. In the office, the surgeon decided to evacuate it with three punctureslike little incisions at the inferior part of the skin tip with a trocar 18G. Through them, drained brownish purulent secretion. With the same trocar, rifampicin solution was injected through these little incisions, like washing the subdermal area. It was medicated with trimethoprim-sulfamethoxazole (Bactrim forte®) 2 tablets/day. The following day, there was a clear improvement in the congestion and erythema of the nose. This procedure of washing was repeated for four days. There was a quick evolution of the inflammatory process and 20 more days, there was no sign of the infection. Four months later, the tip of the nose was soft and the result was considered optimal by the patient and doctors.

Coxiella burnetii, the agent of Q fever in Brazil: its hidden role in seronegative arthritis and the importance of molecular diagnosis based on the repetitive element IS1111 associated with the transposase gene.

Coxiella burnetii is the agent of Q fever , an emergent worldwide zoonosis of wide clinical spectrum. Although C. burnetii infection is typically associated with acute infection, atypical pneumonia and flu-like symptoms, endocarditis, osteoarticular manifestations and severe disease are possible, especially when the patient has a suppressed immune system; however, these severe complications are typically neglected. This study reports the sequencing of the repetitive element IS1111 of the transposase gene of C. burnetii from blood and bronchoalveolar lavage (BAL) samples from a patient with severe pneumonia following methotrexate therapy, resulting in the molecular diagnosis of Q fever in a patient who had been diagnosed with active seronegative polyarthritis two years earlier. To the best of our knowledge, this represents the first documented case of the isolation of C. burnetii DNA from a BAL sample.

Coxiella burnetii, the agent of Q fever in Brazil: its hidden role in seronegative arthritis and the importance of molecular diagnosis based on the repetitive element IS1111 associated with the transposase gene

Coxiella burnetii is the agent of Q fever , an emergent worldwide zoonosis of wide clinical spectrum. Although C. burnetii infection is typically associated with acute infection, atypical pneumonia and flu-like symptoms, endocarditis, osteoarticular manifestations and severe disease are possible, especially when the patient has a suppressed immune system; however, these severe complications are typically neglected. This study reports the sequencing of the repetitive element IS1111 of the transposase gene of C. burnetii from blood and bronchoalveolar lavage (BAL) samples from a patient with severe pneumonia following methotrexate therapy, resulting in the molecular diagnosis of Q fever in a patient who had been diagnosed with active seronegative polyarthritis two years earlier. To the best of our knowledge, this represents the first documented case of the isolation of C. burnetii DNA from a BAL sample.

Effects of doxycycline on the endosymbiont Wolbachia in Dirofilaria immitis (Leidy, 1856)--naturally infected dogs.

Dirofilaria immitis carries intracellular endosymbiotic bacteria of the genus Wolbachia, known to be vital for the worms and sensitive to tetracycline antibiotics. With the purpose of studying the interaction between D. immitis and the endosymbiont Wolbachia sp., heartworm naturally infected microfilaremic or antigenemic dogs were treated with doxycycline (10mg/kg/day of the drug in three cycles of 21 days each, with 6-month intervals). Blood samples were collected on days 0, 7 and 21 of each treatment as well as on day 111 after the beginning of each cycle. A final sample was collected on day 723 from the beginning of the first treatment. The samples were examined for the presence and number of microfilariae and the presence of antigen as well as the presences of D. immitis and Wolbachia sp. DNA using PCR (polymerase chain reaction). With this approach, an evaluation of the effect of doxycycline on antigenemia and on the presence of Wolbachia sp. DNA in dogs with heartworm infection was possible. Doxycycline treatment did not alter the detection of adult parasite antigens with the exception of two animals, though the number of animals carrying Wolbachia sp. DNA decreased, despite the presence of the microfilariae. The effect of the antibiotic therapy on the worms may have interfered with the transmission of heartworm disease because the population of microfilariae and the number of microfilaremic dogs were reduced and the microfilariae positive samples that were found did not test positive for Wolbachia sp. in many cases. These findings suggest that in areas were doxycycline is extensively used D. immitis transmission may be impaired by the reduction on the number of microfilariae and on the endosymbiotic bacteria in the larvae turning them incapable of completing development once they infected a new host.

Detection of Wolbachia DNA in blood from dogs infected with Dirofilaria immitis.

Dirofilaria immitis is the causative agent of heartworm disease in canines and felines, and pulmonary dirofilariasis in man. It harbors a symbiotic intracellular bacterium from the genus Wolbachia that plays an important role in its biology and contributes to the inflammatory pathology of the heartworm. This endosymbiont is sensitive to the tetracycline family of antibiotics prompting its use in the treatment of filariasis. To track Wolbachia during treatment, primers were designed based on the FtsZ gene from Wolbachia. These primers amplify a single PCR product with the expected size from DNA samples derived from various species of worms that harbor Wolbachia (D. immitis, Brugia malayi and Brugia pahangy). The detection limit of Wolbachia DNA in the assay was 80 pg of D. immitis DNA. Furthermore, the primer set successfully amplified the expected PCR product using blood samples from dogs harboring the heartworm and circulating microfilariae.

[The effect of different strains Babesia bovis (Babes, 1888) on tick of Boophilus microplus (Canestrini, 1887)]. / Efeito de diferentes amostras de Babesia bovis (Babes, 1888) em carrapatos Boophilus microplus (Canestrini, 1887).

Two samples (modified and no-modified) of Babesia bovis, were used to evaluate the effect on engorged females of Boophilus microplus Babesia spp - free. For so much, were used three holstein breed bovine, males with 6 months of age, (BH1, BH2 and BH3), coming of the Plateau of Itatiaia, Rio de Janeiro, Brazil. Each calf was infested with 0.2g of B. microplus larvae Babesia spp- free, for 10 consecutive days. They were inoculated in the calves BH1 and BH2, modified and no modified sample, respectively. After natural fall of adults ticks from the vertebrate host, 100 engorged females of each host (BH1, BH2 and BH3) were incubated in BOD, with superior Relative Humidity up 80%, Temperature of 28 degrees C, were appraised daily until the 12th day post incubation (dpi.). In the group of the engorged females obtained of calf BH1, infection of ticks was not observed, to the haemolymph exam and oviposture. The sporokinets absence in these samples was related with the successive passages in splenectomized calves and the criopreservation of the sample. In engorged females from BH2 it was observed rates of infection of 100% and 82% of mortality in 7th dpi. and 100% until 12nd dpi., as the oviposture, 70% did not make oviposition and 30% made it until 7th dpi.

Dinâmica da infecção de Babesia bovis (Babés, 1888, Starcovici, 1893) em fêmeas ingurgitadas e ovos de Boophilus microplus (Canestrini, 1887) / Dynamic of infection of Babesia bovis (Babés, 1888, Starcovici, 1893) in engorged females and eggs of Boophilus microplus (Canestrini, 1887)

A dinâmica da infecção de B. bovis no carrapato-vetor B. microplus foi estudada em condições laboratoriais na Universidade Federal Rural do Rio de Janeiro no Laboratório de Protozoologia. Para tanto, foram examinadas 100 fêmeas ingurgitadas que se desprenderam naturalmente do hospedeiro vertebrado, sendo que 84 fêmeas apresentaram-se infectadas com esporocinetos de B. bovis, com a seguinte distribuição: 39 por cento, 33 por cento, e 12 por cento nos dias 3, 4 e 5 de incubação, respectivamente. Foram obtidas amostras de ovos provenientes das fêmeas positivas para B. bovis, 100 por cento das amostras de ovos estavam infectadas, apresentado a seguinte distribuição: 46,4 por cento, 34,5 por cento, 16,7 por cento e 2,4 por cento nos dias 4, 5, 6 e 7 de incubação, respectivamente. As freqüências acumuladas, tanto de fêmeas infectadas (84 por cento) quanto de ovos infectados (100 por cento) mantiveram-se até o 17° dia de incubação. De acordo com as freqüências acumuladas e o aumento do grau de infecção, conclui-se que amostras coletadas a partir do 5° e 7° dia de incubação, são ideais para o diagnóstico de B. bovis, em hemolinfa e ovos, respectivamente.

[Morphologic characterization and biological aspects of evolutive forms of Babesia bigemina (Smith and Kilborne, 1893) (Protozoa: Babesiidae) in Boophilus microplus (Canestrini, 1887)]. / Caracterizçã morfológica e aspectos biológicos das formas evolutivas de Babesia bigemina (Smith; Kilborne, 1893) (Protozoa: Babesiidae) em Boophilus microplus (Canestrini, 1887).

The development of Babesia bigemina in Boophilus microplus were studied in experimental conditions, using crossed-breed bovine from free-area of these parasites. Stages of the hemoparasites were observed in the tick vector, starting from the infected red-blood cells observed in the gut of engorged females, from the first 24 hours after detachment to the emergence of sporokinets in the larvas. In the period from 24 to 48 hours after detachment of the engorged females (DEF), the presence of some infected red-blood cells was verified, beside the occurrence of ray bodies and of vermiculars forms, known as oocynets. Since 72 hours after the DEF, the of okinets presence was observed in the cytoplasm of the epithelium cells besides of great sporokinets number in development. At same period, the presence of sporokinets of B. bigemina in the hemolymph samples was observed inside the hemocytes. After the fourth day of incubation beside the presence of the sporokinets was also verified in the Malpighi's tubes and ovaries. As well as in the ticks eggs from the sporokinets were also observed ticks eggs from the fourty day after the natural detachment of the engorged females of the host.

Long-term exacerbation by interleukin 13 of IgE-mediated eosinophilia in rats.

Recent work shows that at least two cycles of antigen challenge applied in a 7-day interval are required to yield tissue eosinophil accumulation in IgE-passively sensitized rats. Since interleukin (IL)-13 is widely regarded as a key mediator in eosinophilic responses associated with mast cells and IgE, we investigated whether this cytokine could replace the first cycle of sensitization and challenge in its proeosinophilic role. We found that IL-13 (25 and 50 ng/cavity) injected into the rat pleural space led to eotaxin generation and a dose-dependent accumulation of eosinophils following IgE-passive sensitization and challenge 7 days later. IL-13 failed to cause eosinophil chemotaxis in vitro but induced eosinophil accumulation into the pleural cavity of naïve rats, which peaked 1 day and faded 72 h post-challenge. No changes were found 1 week after intrapleural injection of IL-13, except an approximately 40-50% increase in the number of adhered and non-adhered pleural mast cells. As recovered from the pleural effluent 1 week after IL-13, mast cells expressed the same amount of IgE bound on their surface as compared to controls. However, they generated 3-fold more LTC(4) following IgE-sensitization and challenge in vitro, keeping intact the amount of histamine released. Finally, pretreatment with zileuton (50 microg/cavity) 1 h before allergen challenge prevented eosinophil accumulation in those animals injected with IL-13 1 week before. In conclusion, our findings show that IL-13 causes a long-term exacerbation of the IgE-mediated eosinophilic response in a mechanism associated with heightened cysteinyl-leukotriene (cys-LT) production by resident mast cells.