Eliminação transepidérmica de parasitas na doença de Jorge Lobo

Abstract

Resumo: FUNDAMENTOS: A eliminação transepidérmica de parasitas (ETEP) tem sido pouco estudada na doença de Jorge Lobo. OBJETIVOS: Identificar aspectos morfológicos da ETEP na doença de Jorge Lobo. MÉTODOS: Recortes de biópsias de doença de Jorge Lobo emblocados em parafina foram corados pela hematoxilina-eosina e examinados. Considerou-se como ETEP, exclusivamente, a presença de parasitas em estruturas epidérmicas. RESULTADOS: Foram incluídas no estudo 40 biópsias de 37 pacientes (31 homens e seis mulheres, média de idade 51,03 anos, variação 29-80 anos) realizadas em um período de 37 anos , das quais foram obtidos 511 cortes (média de 12,77 cortes por caso, variação 2-39 cortes por caso). Observou-se ETEP em 110/511 (21,52%) e não se observou em 401/511 cortes (78,48%) (p < 0,0001). Em relação aos pacientes (37), em 15 se verificaram aspectos consistentes com ETEP (40,5%), ao passo que, em 22 deles (59,5%), isso não foi observado (p > 0,05). Os parasitas dispunham-se em infundíbulos hiperplásicos, formando catênulas, ou como unidades isoladas, associados ou não a células inflamatórias. CONCLUSÕES: Aspectos consistentes com ETEP, embora observados em número estatisticamente não significante de pacientes da amostra (p > 0,05), sugerem que, na doença de Jorge Lobo, o fenômeno, invariavelmente, ocorra através do epitélio infundibular. Estudos futuros serão necessários para avaliar sua eventual importância na epidemiologia da micose. Palavras-chave: Doença granulomatosa crônica; Micoses; Micoses/patologia; Pele Abstract: BACKGROUND: Few studies have focussed on the transepidermal elimination of parasites in Jorge Lobo's disease (lobomycosis). OBJECTIVE: To identify the morphological features of the transepidermal elimination of parasites in lobomycosis. METHODS: Sections were obtained from paraffin-embedded biopsy specimens of patients with lobomycosis and stained with hematoxylin-eosin for microscopic examination. Only the presence of parasites in epidermal structures was considered to constitute transepidermal elimination. RESULTS: Forty biopsies from 37 patients were included in the study (31 males and 6 females). The mean age of patients was 51.03 years (range 29-80 years). Biopsies performed over a period of 37 years were used, from which 511 sections were obtained (a mean of 12.77 sections per case; range 2-39 sections per case). Transepidermal elimination of parasites was found in 110/511 (21.52%) and was absent in 401/511 sections (78.48%) (p<0.0001). Features consistent with the phenomenon were found in 15/37 patients (40.5%) and were absent in 22/37 (59.5%) (p>0.05). Parasites in the epidermis were detected within hyperplastic infundibula, either connected in chains or as isolated units, associated or not with inflammatory cells. CONCLUSION: Features consistent with transepidermal elimination of parasites were found in a statistically nonsignificant number of patients in the sample (p>0.05), suggesting that in Jorge Lobo's disease, this phenomenon invariably occurs through the infundibular epithelium. Fut...

Lobomycosis: epidemiology, clinical presentation, and management options

“…116 Hyperplastic infundibulum is associated with transepidermal elimination of the fungus. 113 This phenomenon has already been documented and is the basis for the vinyl adhesive tape technic. 112 …”

“… 115 Acanthotic areas with the presence of hyperkeratosis, spongiosis, and neutrophil collection may be observed. 113 Those changes are probably elicited by the presence of the fungus in the epidermis. 116 Hyperplastic infundibulum is associated with transepidermal elimination of the fungus.…”

“…Those are called pseudo-Gaucher cells. 113 A great number of fungal structures are found within the macrophages or in the dermis. Lymphocytes are present in discrete to moderate numbers, with a predominance of CD4 T lymphocytes and a CD4:CD8 ratio of approximately 3:2.…”

Multiple confluent reddish nodules

“…Lobomycosis is a chronic infectious granulomatous disease of the dermis and hypodermis caused by the fungus Lacazia loboi [1,2]. There is no involvement of internal organs or external mucosas, but regional lymph nodes may be affected in 10–25% of the cases.…”

“…The infection is acquired by traumatic inoculation or contact of contaminated material with injured skin [1,2]. There is no transmission of the disease between humans, except for some reports of voluntary inoculation or inadvertent surgical contamination [7,8,9].…”