The diagnosis of American Tegumentary Leishmaniasis is a difficult but essential task
when considering the high toxicity profile of the drugs available. Since the
discovery of its etiologic agent, numerous diagnostic tests have been developed. None
of the tests available today can be considered as the gold standard, since they do
not add enough accuracy for the disease detection. Good epidemiological and clinical
knowledge of the disease are fundamental precepts of the dermatology practice and
precede the rational use of existing diagnostic tests. In this article we aim,
through extensive literature review, to recall fundamental concepts of any diagnostic
test. Subsequently, based on this information, we will weave important comments about
the characteristics of existing diagnostic tests, including immunological tests such
as Montenegro's skin test, serology and detection of parasites by direct examination,
culture or histopathology. Finally we will discuss the new technologies and options
for the diagnosis of Cutaneous Leishmaniasis. The molecular biology technique is
considered a promising tool, promoting the rapid identification of the species
involved. We also aim to educate dermatologists about a disease with high morbidity
and assist in its difficult recognition.
O período gestacional não é isento de infecções que comprometam a saúde materno-fetal, de forma especial aquelas que se apresentam assintomáticas ou subclínicas. Nessas situações, o tratamento, em geral, não seria necessário. Entretanto, os riscos da transmissão materno-fetal (vertical)
Onychomycosis is a common disease, accounting for up to 50% of all ungual
pathologies. We have been developing a clinical trial (ClinicalTrials.gov:
NCT01528813) using a 2940nm Er:YAG laser to fractionally ablate human nails in vivo,
aiming to increase topical amorolfine lacquer delivery to the nail unit, increasing
the efficacy of topical treatment of distal and lateral subungual onychomycosis.
Partial results have shown an increase in areas of nail plate free of disease. We
believe that ablative lasers can increase the efficacy of topical onychomycosis
treatment.
Leprosy is a disease caused by Mycobacterium leprae that carries a high risk of disability, making early diagnosis mandatory. This study aimed to determine the applicability of anti-PGL-1 IgM antibody detection, using the ML FLOW technique, as an assistant tool for the detection of leprosy infection in asymptomatic household contacts (AHHC) of multibacillary leprosy index cases from Midwest Brazil. Serological changes induced by the prophylaxis of these household contacts with Bacillus Calmette-Guérin (BCG) were also verified. A total of 91 AHHC were assessed, among which, 18.68% (n = 17) presented both positive bacilloscopy and positive anti-PGL-1 IgM serology. Positivity concordance between these two laboratorial exams (Kappa Index = 1; p < 0.001) was indicated, however, one case did not demonstrate concordance between the semiquantitative assessment of anti-PGL-1 IgM and the bacilloscopy index (Kappa Index = 0.96; p< 0.001). Among the 17 AHHC with positive bacilloscopy, eight were reassessed after prophylaxis with BCG and two of them presented negative anti-PGL-1 IgM serology, being these patients who had presented a bacilloscopy index of < 2[+] in the initial assessment. This study shows that anti-PGL-1 IgM detection may be used as a tool to determine the bacillary load in AHHC and to detect immune changes related to prophylaxis by nonspecific vaccination.
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