RESUMO

BACKGROUND: Visceral leishmaniasis (VL), or kala-azar, is a common comorbidity in patients with AIDS in endemic areas. Many patients continue to experiences relapses of VL despite virological control, but with immunological failure. These patients remain chronically symptomatic with hypersplenism, for example with anemia, leukopenia, and thrombocytopenia, and are at risk of severe co-infection due to low CD4+ count. Therefore, in this study, splenectomized patients with VL and HIV infection were investigated to understand why the CD4+ count fails to recover in these patients, evaluating the importance of spleen mass for hypersplenism and immunological failure. METHODS: From a retrospective open cohort of 13 patients who had previously undergone splenectomy as salvage therapy for relapsing VL, 11 patients with HIV infection were investigated. This study compared the patients' complete blood cell count (CBC) and CD4+ and CD8+ cell counts before and after splenectomy with respect to spleen weight. RESULTS: CBC was substantially improved after splenectomy, indicating hypersplenism. However, to the best of our knowledge, this is the first study to show that spleen mass is strongly and negatively correlated with CD4+ cell count (ρ = -0.71, P = 0.015). CONCLUSIONS: This finding was unexpected, as the spleen is the most extensive lymphoid tissue and T-lymphocyte source. After reviewing the literature and reasoning, we hypothesized that the immunological failure was secondary to CD4+ loss initially by apoptosis in the spleen induced by productive HIV infection and, subsequently, by pyroptosis sustained by parasitic infection in spleen macrophages.

Assuntos

Assuntos

Assuntos

RESUMO

Occult breast cancer (OBC) is characterized by metastatic presentation of undetectable breast tumor on imaging exams. OBC is a rare disease (accounting for 0.3% to 1.0% of all breast cancers) that represents a major diagnostic challenge. The aim of this study was to report a case of OBC with primary presentation of multiple cutaneous metastases with subsequent emergence of bone metastasis. A 70-year female patient had multiple cutaneous metastatic lesions in the left cervical region, left breast, left axillary region, left subscapular region, in three chirodactylus of the right hand and three chirodactylus of the left hand. Imaging tests (mammogram, ultrasonography and magnetic resonance imaging of the breast) did not show alterations. Biopsy, histology sections and immunohistochemistry of the left cervical cutaneous lesion were compatible with OBC. After two years of anastrozole treatment (1mg/day), there was regression of all cutaneous lesions and stabilization of bone metastasis. OBC has a better prognosis. It may exhibit spontaneous regression or respond to less aggressive treatment strategies, as described in this case.

Assuntos

RESUMO

In Latin America, the causative agent of kala-azar is the intracellular protozoan Leishmania infantum. Most cases in South America are reported in Brazil. Worldwide, it mainly affects Bangladesh, Ethiopia, India, South Sudan and Sudan. Despite the high morbidity and lethality of kala-azar, most infections are asymptomatic. However, a small portion of patients evolves with recurrence of kala-azar becoming symptomatic even after all available drug treatments. Kala-azar is not a formal indication for splenectomy in adults. Splenectomy is recommended as a saving measure, when kala-azar is associated with symptomatic hypersplenism and for drug-resistant cases. In the study, we report two cases of kala-azar with splenomegaly that presented several hospitalizations due to the recurrence of the kala-azar, in addition to hospitalizations for normalizing the blood count. After splenectomy, kala-azar cases and the effects of hypersplenism are cured. Thus, splenectomy should be seen as a surgical treatment option with a curative purpose in patients with recurrent kala-azar, in whom the possibilities of drug therapy have been exhausted and even so they progressed with hypersplenism and clinical repercussions.

Assuntos

RESUMO

INTRODUCTION: Visceral leishmaniasis (VL) represents a public health concern in several areas of the world. In the American continent, VL transmission is typically zoonotic, but humans with active VL caused by Leishmania infantum are able to infect sandflies. Thus, individuals with cutaneous parasitic infections may act as reservoirs and allow interhuman transmission. Additionally, the skin may be responsible for reactivation of the disease after therapy. This study's objective was to evaluate cutaneous parasitism in humans with VL in an American endemic area. METHODS: A cross-sectional hospital-based study was conducted in northeast Brazil from October 2016 to April 2017. Biopsies of healthy skin for histopathology and immunohistochemistry were performed prior to treatment in all study patients. RESULTS: Twenty-two patients between the ages of five months to 78 years were included in the study. Seven patients (31.8%) tested positive for HIV. Only one patient had cutaneous parasitism, as confirmed by immunohistochemistry prior to treatment. Parasitism was not detected after treatment. CONCLUSIONS: Cutaneous parasitism in the healthy skin of humans with visceral leishmaniasis, although unusual, may be a source of infection for phlebotomine sandflies.

Assuntos

RESUMO

Abstract INTRODUCTION: Visceral leishmaniasis (VL) represents a public health concern in several areas of the world. In the American continent, VL transmission is typically zoonotic, but humans with active VL caused by Leishmania infantum are able to infect sandflies. Thus, individuals with cutaneous parasitic infections may act as reservoirs and allow interhuman transmission. Additionally, the skin may be responsible for reactivation of the disease after therapy. This study's objective was to evaluate cutaneous parasitism in humans with VL in an American endemic area. METHODS: A cross-sectional hospital-based study was conducted in northeast Brazil from October 2016 to April 2017. Biopsies of healthy skin for histopathology and immunohistochemistry were performed prior to treatment in all study patients. RESULTS: Twenty-two patients between the ages of five months to 78 years were included in the study. Seven patients (31.8%) tested positive for HIV. Only one patient had cutaneous parasitism, as confirmed by immunohistochemistry prior to treatment. Parasitism was not detected after treatment. CONCLUSIONS: Cutaneous parasitism in the healthy skin of humans with visceral leishmaniasis, although unusual, may be a source of infection for phlebotomine sandflies.

Assuntos

RESUMO

This study aimed to assess the prevalence and influence of urinary tract infection on the reproductive performance of sows. The animals underwent urine tests using reagent strips and diagnosed as positive or negative. They were then divided into two groups of 30 positive and 30 negative sows for urinary tract infection. Each sow was considered an experimental unit and was followed from labor to weaning. The animals were assessed for their reproductive performance (labor duration, number of live births, mummified piglets, and stillbirths, and postpartum diseases). After weaning, the weaning-estrus interval and rate of return to estrus were assessed. A thermographic camera was used to identify hyperthermia of the mammary system and its relation with the onset of urinary tract infections. The prevalence of urinary tract infection in prepartum sows was 41.1%. Urinary tract infection does not impact labor duration, number of live births, mummified piglets, and stillbirths, number of sows culled, weaning-estrus interval, or return to estrus after insemination. However, it was considered a predisposing factor for the occurrence of postpartum vaginal discharge. There is no correlation between the occurrence of urinary tract infection and mammary system temperature in sows.(AU)

Assuntos

RESUMO

Introdução: o Sarcoma de Kaposi (SK) é a neoplasia mais comum em portadores da Síndrome da Imunodeficiência Adquirida (SIDA). É raro o acometimento exclusivo do trato gastrointestinal por essa afecção, ocorrendo em 3,5% dos casos. O objetivo desse estudo é relatar o caso de um paciente portador de SIDA com anemia e vômitos, diagnosticado com SK gastrointestinal. Relato de caso: paciente do gênero masculino, 29 anos, foi admitido no Hospital Universitário (HU/UFPI) devido a sintomas inespecíficos com 1 mês de evolução. Paciente tinha antecedente pessoal de retrovirose. Para investigação dos sintomas, o paciente realizou endoscopia digestiva alta que revelou lesões violáceas sésseis de antro gástrico e duodeno. A análise histopatológica constatou fragmentos de mucosa gástrica e entérica exibindo, em lâmina própria, proliferação de capilares sanguíneos em fenda, células fusiformes atípicas com núcleos hipercromáticos e extravasamento de hemácias. O estudo imuno-histoquímico mostrou que as células neoplásicas expressaram o antígeno nuclear latente-1 do herpesvírus humano 8 (HHV8 LNA1; clone LN53, diluição 1:25, Diagnostic Biosystems, Pleasanton, CA) em padrão nuclear, confirmando o diagnóstico de SK. Em decorrência de múltiplas complicações e agravamento clínico, o paciente foi a óbito após 15 dias da admissão. Discussão e Conclusão: incidência de SK gastrointestinal é subestimada. Estômago, duodeno e o trato biliar são os locais mais comumente acometidos. A detecção do HHV-8 por imuno-histoquímica é uma ferramenta útil, especialmente na lesão inicial em que o caráter neoplásico não é evidente. A mortalidade dos pacientes com SK gastrointestinal exclusivo é significantemente maior em relação aos que não têm esse tipo de acometimento. Tal fato pode explicar o prognóstico reservado do paciente relatado no presente caso.

Introduction: Kaposi sarcoma (KS) is the most common malignancy in patients with Acquired Immunodeficiency Syndrome (AIDS). It is rare the exclusive involvement of the gastrointestinal tract by this condition, occurring in 3.5% of cases. The aim of this study is to report the case of an HIV-infected patient with anemia and vomiting diagnosed with gastrointestinal KS. Case report: a 29-year-old male patient admitted to the University Hospital (HU/UFPI) due to non-specific symptoms with one month of evolution. He had personal history of retrovirus. To research the symptoms, the patient underwent upper endoscopy that revealed sessile purplish lesions of gastric antrum and duodenum. Histopathological analysis found gastric and enteric mucosa fragments exhibiting in lamina propria proliferation of blood capillaries with formation of slit like spaces, atypical spindle cells with hyperchromatic nuclei and extravasation of red blood cells. Immunohistochemical study showed that tumor cells expressed human herpesvirus 8 latent nuclear antigen-1 (HHV-8 LNA1; clone LN53, dilution 1:25, Diagnostic Biosystems, Pleasanton, CA) in nuclear pattern, confirming the diagnosis of KS. Because of multiple complications and clinical worsening, the patient died after 15 days of admission. Discussion and Conclusion: the incidence of gastrointestinal KS is underestimated. Stomach, duodenum and biliary tract are the most commonly affected sites. The detection of HHV-8 for immunohistochemistry is a useful tool, particularly in the initial lesion in which the neoplastic character is not evident. The mortality of patients with exclusive gastrointestinal KS is significantly higher than those who do not have that involvement. This may explain the poor prognosis of the patient reported in this case.

Assuntos

RESUMO

Relato de caso de um osteossarcoma metaplásico da mama em um hospital de Teresina, com resumo e discussão de literatura. O carcinoma metaplásico da mama é mais comum em mulheres entre 55 e 60 anos. Apresenta-se em forma de uma massa palpável sem preferência por quadrante, com rápido crescimento e geralmente é mais largo do que outros tipos de tumores mamários. Os carcinomas têm poucos receptores para hormônios sexuais. No caso de carcinoma metaplá- sico com diferenciação osteossarcomatosa, sua apresentação é bem agressiva. A decisão sobre o tratamento apresenta di culdades em função do baixo número de casos relatados na literatura. Neste relato, apresenta-se uma paciente com carcinoma metaplásico e diferenciação osteossarco- matosa no quadrante superior da mama direita. Foi realizada uma mastectomia com ressecção da pele do quadrante e do segmento do músculo peitoral in ltrado pelo tumor, com preservação do restante da pele e do complexo papiloareolar. Serão discutidas as descobertas patológicas. Devido às diversas opções de tratamento disponíveis para a paciente, conclui-se que mais estudos devem ser realizados sobre qual terapêutica possui maior impacto no prognóstico do paciente, bem como o papel da radioterapia/quimioterapia no paciente.

is is a case report of an osteosarcomatoid metaplastic breast carcinoma in a hospital in Teresina, Brazil, with review and discussion on the theme. Breast metaplastic carcinoma is more common in women aged 55 and 60 years old. It is usually in the form of a palpable mass with no predilection for any quadrant and rapid growth and is generally larger than other types of breast tumors. ese tumors have few receptors for sex hormones. In the case of metaplastic carcinoma with osteosarcomatoid di erentiation, its presentation is quite aggres- sive. A decision on the treatment procedure presents di culties due to the low number of cases reported in the literature. In this report, we present a patient with metaplastic carcinoma and sarcomatoid di erentiation in the right upper quadrant of the right breast. It was performed a mastectomy with quadrant skin resection and segment of the pectoral muscle in ltration by the tumor with preservation of the rest of the skin and papiloareolar complex. It will be discussed the pathological ndings. Due to the several treatment options available to the patient, it can be concluded that more studies must be done on what kind of treatment has the greatest impact on patient prognosis, as well as the role of radiotherapy/chemotherapy on patient.