RESUMO
INTRODUCTION: Episodes of acute adenolymphangitis (ADL) are often the first clinical sign of lymphatic filariasis (LF). They are often accompanied by swelling of the affected limb, inflammation, fever, and general malaise and lead to the progression of lymphedema. Although ADL episodes have been studied for a century or more, questions still remain as to their etiology. We quantified antibody levels to pathogens that potentially contribute to ADL episodes during and after an episode among lymphedema patients in Léogâne, Haiti. We estimated the proportion of ADL episodes hypothesized to be attributed to specific pathogens. METHODS: We measured antibody levels to specific pathogens during and following an ADL episode among 41 lymphedema patients enrolled in a cohort study in Léogâne, Haiti. We calculated the absolute and relative changes in antibody levels between the ADL and convalescent time points. We calculated the proportion of episodes that demonstrated a two-fold increase in antibody level for several bacterial, fungal, and filarial pathogens. RESULTS: Our results showed the greatest proportion of two-fold changes in antibody levels for the carbohydrate antigen Streptococcus group A, followed by IgG2 responses to a soluble filarial antigen (BpG2), Streptococcal Pyrogenic Exotoxin B, and an antigen for the fungal pathogen Candida. When comparing the median antibody level during the ADL episode to the median antibody level at the convalescent time point, only the antigens for Pseudomonas species (P-value = 0.0351) and Streptolysin O (P-value = 0.0074) showed a significant result. CONCLUSION: Although our results are limited by the lack of a control group and few antibody responses, they provide some evidence for infection with Streptococcus A as a potential contributing factor to ADL episodes. Our results add to the current evidence and illustrate the importance of determining the causal role of bacterial and fungal pathogens and immunological antifilarial response in ADL episodes.
Assuntos
Anticorpos Antibacterianos/sangue , Anticorpos Antifúngicos/sangue , Anticorpos Antiprotozoários/sangue , Linfangite/etiologia , Streptococcus pyogenes/imunologia , Adulto , Animais , Anticorpos Antibacterianos/imunologia , Anticorpos Antifúngicos/imunologia , Anticorpos Antiprotozoários/imunologia , Estudos de Coortes , Filariose Linfática/etiologia , Feminino , Haiti , Humanos , Linfangite/sangue , Linfangite/imunologia , Linfedema/sangue , Linfedema/imunologia , Masculino , Wuchereria bancrofti/imunologiaRESUMO
Eccrine porocarcinoma is a potentially fatal form of sweat gland carcinoma, due to its propensity to metastasize through lymph vessels. The authors report the case of a 69-year-old female who presented with swelling of the right leg and an ulcerated lesion of the right great toe. The initial histologic diagnosis was invasive squamous cell carcinoma. On follow-up, the patient developed lymphangitic tumor spread in the right leg, associated with right inguinal lymphadenopathy and lesions in vulva and flank. Reevaluation of the toe lesion led to a revised diagnosis of eccrine porocarcinoma. The patient also had 2 basal cell carcinomas of the multicentric/superficial type in the skin overlying the left breast. Past history included chronic ingestion of liquore arsenic (Fowler's solution) in early adulthood as treatment for dermatitis herpetiformis.
Assuntos
Intoxicação por Arsênico/etiologia , Arsenitos/efeitos adversos , Porocarcinoma Écrino/secundário , Linfangite/patologia , Compostos de Potássio/efeitos adversos , Neoplasias das Glândulas Sudoríparas/patologia , Idoso , Arsenitos/uso terapêutico , Carcinógenos , Carcinoma Basocelular/complicações , Carcinoma Basocelular/etiologia , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/diagnóstico , Diagnóstico Diferencial , Porocarcinoma Écrino/complicações , Porocarcinoma Écrino/etiologia , Feminino , Humanos , Ceratite Herpética/tratamento farmacológico , Linfonodos/patologia , Linfangite/complicações , Linfangite/etiologia , Neoplasias Primárias Múltiplas , Compostos de Potássio/uso terapêutico , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologia , Neoplasias das Glândulas Sudoríparas/complicações , Neoplasias das Glândulas Sudoríparas/etiologiaAssuntos
Micetoma/diagnóstico , Scedosporium/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Artrite Infecciosa/complicações , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/microbiologia , Artrite Infecciosa/cirurgia , Bacteriemia/complicações , Ciprofloxacina/uso terapêutico , Terapia Combinada , Desbridamento , Drenagem , Quimioterapia Combinada , Glomerulonefrite/complicações , Humanos , Hospedeiro Imunocomprometido , Itraconazol/uso terapêutico , Linfangite/etiologia , Masculino , Micetoma/complicações , Micetoma/tratamento farmacológico , Micetoma/cirurgia , Abscesso do Psoas/etiologia , Abscesso do Psoas/microbiologia , Abscesso do Psoas/cirurgia , Infecções Estafilocócicas/complicações , Vancomicina/uso terapêuticoRESUMO
OBJECTIVES: An estimated 15 million persons suffer from lymphoedema of the leg in filariasis-endemic areas of the world. A major factor in the progression of lymphoedema severity is the incidence of acute dermatolymphangioadenitis (ADLA), which is triggered by bacteria that gain entry through damaged skin, especially in the toe web spaces ('interdigital skin lesions'). Little is known about the epidemiology of these skin lesions or about patients' awareness of them. METHODS: We interviewed and examined 119 patients (89% women) with lymphoedema of the leg in Recife, Brazil, an area endemic for bancroftian filariasis. RESULTS: We detected 412 interdigital skin lesions in 115 (96.6%) patients (mean, 3.5 lesions per patient, range 0-8). The number of interdigital skin lesions was significantly associated with lymphoedema stage (P<0.001) and frequency of ADLA (P<0.0001). Only 20 (16.8%) patients detected their own interdigital skin lesions or considered them abnormal. Patients reported a mean of 3.6 ADLA episodes during the previous 12 months (range, 0-20); reported ADLA incidence was associated with lymphoedema stage (P<0.0001) and the number of interdigital skin lesions detected by the examining physician (P<0.0001). CONCLUSIONS: These data suggest that interdigital skin lesions are a significant risk factor for ADLA and that persons with lymphoedema in filariasis-endemic areas are unaware of their presence or importance. Prevention of ADLA through prompt recognition and treatment of interdigital skin lesions will require that patients be taught to identify lesions, especially between the toes and to recognize them as abnormal.
Assuntos
Filariose Linfática/epidemiologia , Doenças do Pé/epidemiologia , Dermatopatias Parasitárias/epidemiologia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Filariose Linfática/complicações , Doenças Endêmicas , Feminino , Doenças do Pé/parasitologia , Humanos , Linfadenite/epidemiologia , Linfadenite/etiologia , Linfangite/epidemiologia , Linfangite/etiologia , Masculino , Pessoa de Meia-Idade , Dermatopatias Parasitárias/etiologia , Dedos do PéRESUMO
INTRODUCTION: Nocardia brasiliensis is a very rarely reported cause of chronic phagedenic ulcerations. We report the case of an elderly woman who developed such an infection after falling on her right leg on the road in the Bresse country (an essentially agricultural and bovine-cattle breading region) and developed a chronic phagedenic ulcer secondarily complicated by nodular lymphangitis of the thigh. CASE REPORT: A 75 year-old woman fell on her right leg on the side of the main road outside her hamlet in the Bresse country and secondarily developed a chronique phagedenic ulceration. We first considered her as suffering from pyoderma gangrenosum. A complete scanning only revealed an autoimmune thyroiditis and a rapidly healing gastric ulceration, and none of the treatments, either local or systemic, helped the skin condition to heal. After 3 weeks of application of a local corticoid ointment, the patient developed fever, general malaise, an exacerbation of her wound and an infiltration of the skin round her knee, together with nodular lymphangitic dissemination. A supplementary bacterial swab disclosed massive proliferation of a slow-growing Gram-positive bacillus, which proved to be Nocardia brasiliensis, together with a methicillino-sensitive Staphylococcus aureus. The treatment with sulfamethoxazole-trimetoprim gave a rash after 12 hours and was changed to amoxicillin and clavulanic acid, which rapidly proved to be permanently effective. DISCUSSION: The revelation of this particular slow-growing bacteria is difficult and requires bacterial swabs. Nocardia brasiliensis is relatively rare in primary skin ulcerations and we discuss the reasons why an elderly women should find this bacteria on the road outside her hamlet in the French countryside. This particular infectious condition requires general scanning, to make sure that the primary skin condition does not extend to other organs. We review the therapeutical options for patients who exhibit allergic reactions to the classically effective antibiotic drugs.