Comparative dermatology

Abstracts

A dermatologia está ligada a diversas áreas do conhecimento e, de forma inusitada, neste caso, à parasitologia. As oportunidades através da "Dermatologia Comparativa" ampliam essas ligações com criatividade e facilitando a transmissão da mensagem.

Giardia lamblia; tuberculose cutânea; vacina BCG

ICONOGRAPHY

Comparative dermatology^*

Arles Martins Brotas^I; Andrea Cunha Volta^I; Luna Azulay-Abulafia^II; Leninha Valério do Nascimento^III

^IResident, specializing in Dermatology at the College of Medical Sciences, University of Rio de Janeiro State

^IIAssistant Professor of Dermatology at the College of Medical Sciences, University of Rio de Janeiro State

^IIITitular Professor of Dermatology at the College of Medical Sciences, University of Rio de Janeiro State

^{Correspondence}

SUMMARY

Dermatology is related to other areas of knowledge and in this case, in an unusual manner, to parasitology. The opportunities offered by "Comparative Dermatology" amplify these relationships with creativity and facilitate the transmission of the message.

Key words:Giardia lamblia; tuberculosis, cutaneous; BCG vaccine.

BCG (Bacille Calmette-Guérin) vaccine appeared between 1909 and 1916, prepared through the attenuation in vitro of the bacillus Micobacterium bovis by Calmette and Guérin. Its function is to protect the host by blocking the hematogenic spread of the pathogen, thereby limiting the primary infection to subclinical proportions. The resultant protection lasts for 15 years.¹

BCG vaccination can cause benign papular, pustular lesions or self-limiting ulceration, leaving a residual scar. Occasionally, abscesses can form in individuals that already had contact with the bacillus, or due to infusion of an incorrect volume or also due to an overly deep injection. Furthermore, it can provoke nonspecific complications, such as erythema nodusum, exanthematous eruptions, granulomas, epithelial cysts and keloid scars,^2,3 as well as specific lesions of vulgar lupus, scrofuloderma, intense regional lymphadenitis (most common complication), subcutaneous abscesses and tuberculoid type eruptions. In addition it can be responsible for Koch's phenomenon that corresponds to necrosis and ulceration that is frequently associated with regional lymphadenitis. This reaction occurs in individuals previously sensitized to the bacillus.²

In the case reported here, 15 days after vaccination a male, six-year-old child coursed with ulceration and axillary lymphangitis persisting for three months without modification. Surprisingly, two parallel ulcerated lesions appeared, with indurated papular borders, with surrounding erythema, that assumed an aspect very similar to that of Giardia lamblia protozoa in its trophozoite form (Figure 1). Giardia lamblia can present a cystic form (infectious and highly resistant) as well as the trophozoite form that has pear-shaped format, with bilateral symmetry corresponding to the erythematous-infiltrated area of the lesion. From the ventral view, its two nuclei, correspond to ulcers in a parallel arrangement (Figure 2). The Giardia genus was possibly the first human intestinal protozoan to be discovered. The initial description of the trophozoite has been attributed to Anton van Leeuwenhoek (1681), and the denominations Giardia lamblia, Giardia duodenalis and Giardia intestinalis have been used as synonyms.⁴

Giardiasis is a cosmopolitan disease. The clinical picture can present just a few hours after ingestion of the protozoa and usually includes diarrhea or constipation, dyspepsia, abdominal pain and can cause systemic manifestations such as fever, articular pain and widespread pruritus.⁵ It is one of the main causes of diarrhea in children, leading to problems of malnutrition and developmental retardation.⁴ The first choice treatment is 2g Secnidazol, in a single dose of four tablets for adults or 30mg/kg/day for children.⁵

REFERENCES

1. Gawkkodgr. D.J. Mycobacterial Infections. In: Rook, Wilkinson, Ebling. Textbook of Dermatology: Oxford: Blackwell ,1998:1181-1214

2. Sampaio SAP, Rivitti EA. Tuberculose e Micobacterioses Atípicas. Dermatologia. 1ª ed. São Paulo: Artes Médicas, 1998:453-66.

3. Tappeiner G, Wolff K. Tuberculosis and Other Mycobacterial Infections. In: Freedberg IM, Eisen AZ, Wolff K, et al. Fitzpatrick's Dermatology in General Medicine: New York: McGraw-Hill, 1999: 2274-2288.

4. Sogayar MITL, Guimarães S. Giardia lamblia. In: Parasitologia. 107-13.

5. Soli ASV. Parasitoses intestinais. In: Schechter M, Marangoni DV. Doenças Infecciosas. Conduta Diagnóstica e Terapêutica. 2ª ed. Rio de Janeiro: Guanabara Koogan, 1998: 414-24.

Received in September, 04^th of 2002

Approved by the Editorial Council and accepted for publication in September, 05^th of 2002

Prezado(a) colega,

A seção Iconografia procura apresentar fotografias de casos clínicos que possam vir a ter semelhança com aspectos de outra natureza. Se você tem algum artigo que se encaixe nesta seção, contribua com os Anais Brasileiros de Dermatologia, enviando-o para o nosso endereço:

Av. Rio Branco, 39 / 18^o andar - Centro - Rio de Janeiro - RJ - CEP: 20090-003

Correspondence to

Arles Martins Brotas

Av. 28 de Setembro, 87

Rio de Janeiro RJ 20551-030

Tel.: [phone]

E-mail: [e-mail]

Received in September, 04^th of 2002

Approved by the Editorial Council and accepted for publication in September, 05^th of 2002

* Work done at the Dermatology Dept. of the Teaching Hospital Pedro Ernesto - UERJ.

Prezado(a) colega,

A seção Iconografia procura apresentar fotografias de casos clínicos que possam vir a ter semelhança com aspectos de outra natureza. Se você tem algum artigo que se encaixe nesta seção, contribua com os Anais Brasileiros de Dermatologia, enviando-o para o nosso endereço:

Av. Rio Branco, 39 / 18^o andar - Centro - Rio de Janeiro - RJ - CEP: 20090-003

*

Work done at the Dermatology Dept. of the Teaching Hospital Pedro Ernesto - UERJ.

Publication Dates

• Publication in this collection
  04 June 2004
• Date of issue
  Feb 2004

History

• Received
  04 Sept 2002
• Accepted
  05 Sept 2002