Recovery of adrenal function after treatment of paracoccidioidomycosis.

In endemic areas, the systemic mycosis paracoccidioidomycosis (PCM) is the most frequent etiology of Addison's disease. Paracoccidioides brasiliensis, the causative agent of PCM, exhibits a high tropism for the adrenal glands, which results in a low hormone reserve and in more severe cases, in symptoms of primary adrenal insufficiency. In these cases, the hormone deficit is usually treated with replacement corticoid therapy for the rest of the patient's life. Recently, we identified three patients with disseminated PCM who had adrenal insufficiency; one of them had Addison's disease. All showed complete recovery of adrenal function after a 1-2-year period of specific therapy with ketoconazole or sulfonamides. Plasma cortisol levels were determined by radioimmunoassay of baseline blood samples, as well as those taken after the rapid stimulation test with synthetic adrenocorticotrophic hormone, and before and after the antifungal therapy.

Cutaneous leishmaniasis in Tupí-Mondé Amerindians from the Brazilian Amazonia.

This paper reports the results of a cross-sectional survey aimed at characterizing the epidemiology of American cutaneous leihsmaniasis (ACL) in 3 Tupí-Mondé-speaking Amerindian groups from the Brazilian Amazon region. Data include results of Montenegro skin tests (n = 550), serology (n = 233), and physical examinations (n = 676). Rates of skin test positivity were higher for males and differed between the groups (Gavião 43.0%, Suruí 52.8%, Zoró 68.1%), with a trend toward increase with age. Strong associations were also detected for the presence of suggestive ACL scars, on the one hand, and age, sex, and tribal affiliation, on the other. Although 14.7% of the subjects showed typical scars of past ACL disease, only 3 cases of active primary leishmanial ulcers were observed. The results did not indicate any clear association between seropositivity and positivity to the Montenegro intradermal test or presence of scars. The authors discuss the epidemiology of ACL in the Tupí-Mondé in the light of their ecology and recent history.

Hepatitis B epidemiology and cultural practices in Amerindian populations of Amazonia: the Tupí-Mondé and the Xavánte from Brazil.

Hepatitis B infection and disease are highly endemic in South America. Prevalences of positivity are particularly high in Amazonia, and among Amerindian peoples in particular. This paper reports the results of a seroepidemiological survey for hepatitis B virus (HBV) carried out among four Amerindian populations from the Brazilian Amazon region: Gavião, Surui, Zoro and Navate. Rates of positivity to HBV serological markers (HBsAg, anti-HBs and or anti-HBc) are very high for the four groups, ranging from 62.8 to 95.7%. It is argued that the high rates of positivity in the Amerindian groups dealt with in this study, as well as for other Amazonian populations, are related to a complex of cultural practices which enhance the likelihood of HBV transmission (bloodletting, scarification, tattooing and orally processed food, among others). The authors suggest that, due to unique patterns of interaction between sociocultural and environmental factors. HBV infection assumes a specific profile in native Amazonian societies.

[Thoracic radiologic aspects in paracoccidioidomycosis]. / Aspectos radiológicos torácicos na paracoccidioidomicose.

In this paper the authors analyse 159 radiographs from paracoccidioidomycosis patients seen at the Evandro Chagas Hospital/Fiocruz in the period between January 1960 to December 1988. Twenty four cases (15.09%) of association with tuberculosis were observed; one with pneumoconiosis; one with aspergillosis, and two with carcinoma. Twenty cases were excluded from the radiologic analysis: in 8 of these the diagnosis of tuberculosis occurred concomitantly, and in 12 patients, lung fibrosis due to previous treatment for tuberculosis or paracoccidioidomycosis was present in the 139 remaining cases, the radiographic abnormalities encountered were grouped according to the predominance of lesions at the various lung sites, if alveolar or interstitial, according to Magalhães' (1982) classification modified by the authors: infiltrate 55 cases (39.6%); mist 28 (20.1%); pneumonic 23 (16.6%); nodular 16 (11.5%); micronodular 10 (7.2%), and fibrotic 7 (5.0%). In 113 cases it was possible to follow the regression of the pulmonary process radiologically. In 85 (75.2%) patients, regression took place within 6 months; in 17 (15.0%) cases between 7 and 12 months; in 4 (3.5%) between 13 and 24 months, and in 7 (6.1%) cases no changes in the radiographic pattern were noted.

Clinical and endoscopic findings in the mucosae of the upper respiratory and digestive tracts in post-treatment follow-up of paracoccidioidomycosis patients.

Systematic examination of the upper respiratory and digestive tracts (URDT) was performed in a group of 80 paracoccidioidomycosis (PCM) patients submitted to post-treatment follow-up ranging from 8 months to 17 years. Mucosae of the URDT had been involved prior to specific treatment in 74 patients, distributed as follows: oropharynx, 50 (41 alone, 7 in association with the larynx, and 2 with the nasal mucosa); larynx, 30 (23 alone and 7 in association); and nasal mucosa, 3 (1 alone and 2 in association). Inactive lesions were observed in all the 50 patients with lesions of the oropharynx, 3 of whom with deforming scars (1 with retraction of the tongue and 2 with narrowing of the oral orifice). One case presented a destructive lesion, with perfuration of the palate. Of the other 46 cases, examination showed nacreous white striated scars which were nearly imperceptible in some cases and in others displayed partial retraction of anatomical structures without any alteration of their features. Patients presented a high rate of missing teeth. In 3 patients with involvement of the nasal mucosa, none of whom presented active PCM lesions, 2 still had nasal voices. In 30 patients with lesions of the larynx, 1 suffered a relapse of PCM and 2 developed epidermoid carcinoma. Of the other 27 cases, none of whom had active PCM lesions, 15 presented dysphonia, 3 were tracheotomized, and 9 were asymptomatic.

A case report of intraspinal paracoccidioidomycosis.

The authors report a case of paraplegia caused by a lumbar intraspinal paracoccidioidomycosis (PCM) granuloma. Clinical neurological diagnosis of a compressive spinal cord lesion was confirmed by spinal magnetic resonance imaging (MRI). Patient was submitted to surgery with total excision of the lesion. Histopathological analysis confirmed the diagnosis of PCM. Patient is on sulfamethoxazole/trimethoprim combined with fluconazole and is experiencing positive neurological recovery.

[Paracoccidioidomycosis among the indian group Suruí of Rondonia, Amazonia, Brazil. A case report]. / Paracoccidioidomicose entre o grupo indígena Suruí de Rondônia, Amazônia, Brasil. Registro de caso.

The Authors report a case of paracoccidioidomycosis in a Surui Indian patient from the state of Rondonia, Brazilian Amazon. The subject is an adult male, having been diagnosed on the basis of mycologic, serologic, and radiographic exams. The prescribed therapy was sulphamethoxazole 800 mg associated with trimethoprim 160 mg every 12 hours. A reevaluation of the patient conducted six months after the beginning of chemotherapy indicated overall improvement of his physical condition and of the radiologic picture, negativeness of the test of precipitin in capillary tube, and positiveness of the skin test with paracoccidioidin. The Authors also reviewed the cases of paracoccidioidomycosis described in the region, especially among the Surui Indian population.

Adult T-cell leukemia/lymphoma associated with HTLV-1 infection in a Brazilian adolescent.

We present the case of a 15-year-old patient infected with HTLV-1 who developed a cutaneous T-cell lymphoma, confirmed by histopathological and immunohistochemical examination, as well as clinically and hematologically confirmed leukemia. The patient died 3 months after initial presentation of the disease. The rarity of the disease in this age group justifies the present report.

Treatment of South American blastomycosis (paracoccidioidomycosis) with miconazole by the oral route: an on-going study.

Results are presented from 12 patients of both sexes, whose ages range from 34 to 65 years, observed over a period of 16 months and receiving miconazole treatment for South-American blastomycosis. Ten of them were being treated for the first time and the remaining 2 presented relapses after treatment with other chemotherapeutic agents. The blastomycotic lesions were localized in skin, mucosa, lung and lymphatics. The drug was administered orally, at a dosage of 1 g three times daily. One relapsing patient had his first daily oral dose replaced by an intravenous dose of 200 mg of miconazole diluted in 250 ml of glucose solution during the initial four weeks. The criterion for diagnosis was finding of the fungus in sputum and/or in the material collected through scrapings or biopsy of the lesions. All patients were treated in hospital until the cure was apparent, clinical examinations being conducted weekly and bi-weekly. Bi-weekly laboratory examinations were performed to evaluate the patient's tolerance to the drug. All treated patients presented complete healing of cutaneomucous lesions (mean time: 4 weeks) and involution of lymphatic and pulmonary features (mean time: 4 months). Two of them still presented palpable lymphatics after 5 months of treatment, in spite of the cure of mucosal and pulmonary lesions. Monitoring the progress of the cured patients was and is being carried out quarterly. Currently, this observation period ranges from three to 15 months. Nine patients are still returning and none have shown the reappearance of mycotic lesions. Diarrhoea was the only side-effect observed after a period of therapy, but it was easily controlled by specific medication (kaolin, pectin, &c.). In a single case the treatment was interrupted because of this symptom.(ABSTRACT TRUNCATED AT 250 WORDS)

Polyclonal B cell activation in paracoccidioidomycosis. Polyclonal activation in paracoccidioidomycosis.

Paracoccidioidomycosis (PCM) is often associated with hypergammaglobulinemia and increased serum levels of circulating immune complexes (CIC). In order to investigate whether polyclonal B lymphocyte activation (PBA) is a current process in PCM, we measured the numbers of IgG secreting cells (IgG SC) in the peripheral blood of 16 patients and of 8 healthy controls. The numbers of IgG SC were found to be significantly elevated in PCM patients. We also observed increased serum levels of IgG, IgA and CIC. These data reflect an activation of B lymphocytes in PCM patients.

Paracoccidioidin and histoplasmin sensitivity in Tupí-Mondé Amerindian populations from Brazilian Amazonia.

A cross-sectional epidemiological survey for paracoccidioidomycosis and histoplasmosis, including skin tests with paracoccidioidin and histoplasmin, physical examinations and X-rays, was conducted among three Tupí-Mondé Amerindian populations from Brazilian Amazonia. The study followed the diagnosis of an increasing number of cases of paracoccidioidomycosis among the Suruí in recent years. Positivity rates to paracoccidioidin and histoplasmin (> or = 5 mm of intradermal induration 24-48 h post-injection) were 43.8% and 78.7% for the Suruí, 6.4% and 5.8% for the Gavião and 14.9% and 80.5% for the Zoró, respectively. There was no significant difference in the results for males and females but marked differences were noted across age groups. The results of the univariate analysis were confirmed after adjustment for confounding variables by multiple logistic regression analysis: paracoccidioidin positivity was relatively high in the Suruí and histoplasmin positivity was relatively high in the Suruí and Zoró. The Suruí's greater exposure to Paracoccidioides brasiliensis, the causative agent of paracoccidioidomycosis, is probably associated with their adoption of new subsistence practices. The epidemiology of this mycosis among the Tupí-Mondé appears to be related to the environmental and socio-economic changes taking place in Amazonia.

Chronic pulmonary histoplasmosis in the State of Rio de Janeiro, Brazil.

Three cases of chronic pulmonary histoplasmosis affecting aged patients with chronic obstructive pulmonary disease are reported. They had a history of recurrent episodes of respiratory infection and presented radiological lung lesions inducing a misdiagnosis of chronic pulmonary tuberculosis of the adults. The diagnosis of histoplasmosis, suggested by the immunodiffusion test and the detection of yeastlike cells in smeared and stained sputum, was confirmed by the isolation and identification of Histoplasma capsulatum var. capsulatum in selective media. The treatment was carried out with amphothericin B and ketoconazole or itraconazole. Clinical, radiologic, mycologic and serologic improvement was obtained in all the patients. However, relapses occurred within a period of 1 to 18 months after the interruption of the treatment. Mycological diagnosis and the difficulties observed in the treatment were discussed. In addition data on the epidemiology of histoplasmosis in the state of Rio de Janeiro, Brazil, were presented.

Interpretation and clinical correlation of serological tests in paracoccidioidomycosis.

In order to correlate the findings of two serological tests, double immunodiffusion (IDD) and immunoblotting (IB), with the clinical diagnosis and follow-up of paracoccidioidomycosis (PCM), 325 serum samples from PCM patients were tested at the beginning of specific therapy and after its completion. Group I included 245 PCM patients at the onset of symptoms without treatment. In 221 cases (90.2%) the IDD showed positive reactions and in 24 (9.8%) the results were negative. Of the 24 IDD negative samples, 23 were investigated by IB and were positive. Group II included 80 PCM patients under follow-up after treatment. There were four cases of relapse in which the IDD and IB tests were positive (100%). Among the 76 cases with inactive mycotic infection, the IDD was negative in 71.2% and positive in 28.8%; the IB was positive in all cases (100%). The control group (Group III) included 27 samples from patients with other mycoses, tuberculosis and from healthy individuals. All showed negative IDD tests but positive reactions with IB, which could be abolished by serum dilutions without altering the PCM reactivity. Therefore, the utilization of the IB, an immunoenzymatic method for the diagnosis of PCM, raised the sensitivity to 100%.

Sporotrichosis: an emergent zoonosis in Rio de Janeiro.

During the period from 1987 to 1998, 13 cases of human sporotrichosis were recorded at the Research Center Evandro Chagas Hospital (CPqHEC) in Rio de Janeiro. Two of these patients related scratch by a sick cat. During the subsequent period from July 1998 to July 2000, 66 human, 117 cats and 7 dogs with sporotrichosis were diagnosed at the CPqHEC. Fifty-two humans (78.8%) reported contact with cats with sporotrichosis, and 31 (47%) of them reporting a history of a scratch or bite. This epidemic, unprecedented in the literature, involving cats, dogs and human beings may have started insidiously before 1998.