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Insects and worms
Course
S60
Cl1 El
2
What’s
new in cutaneous
Roger A. Pradinaud ’ . ‘lnstituf
Guyanais Tmpicale Service Dennato-VtWrPologie-C.H.G.-B.R6006-97306 France
Cl I. Inrported
leismaniasis? de Dertnarologie Cayenne,
Parasitology: Phylogenic taxonomy based on isoenzymatic studies, molecular criteria, monoclonal antibodies, intra vectorial behaviour, inoculation in hamster, pathology in man, eco-epidemiological criteria, autorize a modem classification of the genus Leishania. Immunology: Molecular and immune mechanisms in the pathogenesis of cutaneous leishmaniasis, have better knowledge in man after the murine models. The importance of cytokins and cellular differentiation Thi Thz among CD4 T lymphocytes, r61e of NK cells, Langerhans cells and macrophagic activation or inhibition, give a new light on the problems. Clinical classification: 6 clinico-immunological forms can be distinguisted: (LCL) localised cutaneous leishmaniasis, @CL) disseminated cutaneous Ieishmaniasis, (MCL) muco cutaneous leishmaniasis, (DACL) diffuse anergic cutaneous leishmaniasis, (PKCL) post kala-azar cutaneous leishmaniasis, (CVL) cutaneous and visceral leishmaniasis. Leishmaniasis associated with HIV infection is more often reported, but cannot be recognize as a real opportunist infection. Therapy: Pentamidine Isethionate is confirm as the useful1 drug in South American leishmaniasis with a short cure using 4 mg/kg of pentamidine-base with 2 IM injections. Antimoniate of N. methylglucamine associated with IFNy could cure diffuse anergic cutaneous leishmaniasis (DACL). Associated BCG and leishmanian antigen with glucamine can also be of useful interest. Cl 1-3
Insects
W.R. Faber. Academic
and worms Medical
Centec
Anlsteniam,
The
Netherlands
Persistent insect bites are regularly seen in an out-patient department of Tropical Dermatology. Most patients are travellers who have visited a large variety of countries. More than one third of the patients were unaware that they had been bitten. Localization of the skin lesions is mostly on the legs and less frequently on the arms and the body. The clinical picture is that of, frequently excoriated, papules and also nodules or plaques. Lesions may persist for months, even more than one year, Secondary infection may occur and several patients had been treated already with antibiotics during their travel. Histopathology is mostly lymphocytic-histiocytic perivascular infiltrates with admixture of eosinophils in varying intensity. In a minority granuloma formation is seen. Eczematous changes are common. Therapy consists of local corticosteroid treatment, sometimes under hydrocolloid occlusion (Conttexte’) for several weeks. In a few cases oral prednisone treatment is indicated. Creeping eruption, due to infection with larvae of ancylostoma of dogs and cats, is a common imported skin disease. Due to the characteristic clinical picture this is in essence a clinical diagnosis. Treatment consists of tiabendazol cream or, in severe cases, oral albendazol.
demoloses
Cl l-4
Imported
mycotic
infections
G.E. PiCrard. LiPge, Belgium The European importation of foreign mycoses is a historical feature. One of the best examples is the spread of Trichophyton rubrum several decades ago. The current epidemiological situation indicates the emergence of fungal newcomers. Geoclimatic and social environments are the main factors influencing the nature of genuine exotic mycoses. With the ever growing travel opportunities, frequent immigration sollicitations and war-related movements of populations, the epidemiological risk for the importation of unusual fungal infections is increasing in Europe. Some of these diseases are transmissible to the local population of the new geographical location while others show no or little propensity for dissemination. A few dermatophyte species responsible for tinea capitis which were previously confined to remote geographical areas are now present in close communities of immigrants living in large European cities. Some systemic mycoses, such as those caused by Penicillium mameffei and Histoplasma capsulatum were previously prevalent in circumscribed regions of the world. Nowadays, they prevail in severely immuno-compromised patients worldwide. They are considered to be markers of AIDS. 1Cl l-5
Imported
dermatoses:
E. Nunzi, P Fiallo. Centro Morbo
di Hansen,
Genova,
di Riferinrento Italia
Leprosy Nazionale
per il
Migration has always been one the most important ways of transmission of infectious diseases. In Western Europe leprosy is almost exclusively represented by imported cases. For instance, 66 (69%) of the 96 new cases of leprosy diagnosed in Italy between 1990 and 1997 were seen in migrant workers and 25% in Italian citiziens living abroad. As a result leprosy is no longer limited to endemic areas but may occur in any part of Europe. The incidence of leprosy in Europe is very low compared to the number of immigrants from endemic regions. This is probably due to the efficacy of multidrug therapy in endemic countries. Furthermore most immigrants come from urban areas where the prevalence of leprosy is low compared to rural areas. How can leprosy be controlled in Europe? 1. By teaching medical workers, in particular dermatologists, the priciples for clinical diagnosis; 2. By setting up reference laboratoires to confirm the clinical diagnosis of leprosy; 3. By establishing specialized centers that can cope with the medical and social problems related to leprosy, such as treatment of the acute clinical complications prevention and correction of disabilities and social reintegration of cured individuals.
S60
Cl1 El
2
What’s
new in cutaneous
Roger A. Pradinaud ’ . ‘lnstituf
Guyanais Tmpicale Service Dennato-VtWrPologie-C.H.G.-B.R6006-97306 France
Cl I. Inrported
leismaniasis? de Dertnarologie Cayenne,
Parasitology: Phylogenic taxonomy based on isoenzymatic studies, molecular criteria, monoclonal antibodies, intra vectorial behaviour, inoculation in hamster, pathology in man, eco-epidemiological criteria, autorize a modem classification of the genus Leishania. Immunology: Molecular and immune mechanisms in the pathogenesis of cutaneous leishmaniasis, have better knowledge in man after the murine models. The importance of cytokins and cellular differentiation Thi Thz among CD4 T lymphocytes, r61e of NK cells, Langerhans cells and macrophagic activation or inhibition, give a new light on the problems. Clinical classification: 6 clinico-immunological forms can be distinguisted: (LCL) localised cutaneous leishmaniasis, @CL) disseminated cutaneous Ieishmaniasis, (MCL) muco cutaneous leishmaniasis, (DACL) diffuse anergic cutaneous leishmaniasis, (PKCL) post kala-azar cutaneous leishmaniasis, (CVL) cutaneous and visceral leishmaniasis. Leishmaniasis associated with HIV infection is more often reported, but cannot be recognize as a real opportunist infection. Therapy: Pentamidine Isethionate is confirm as the useful1 drug in South American leishmaniasis with a short cure using 4 mg/kg of pentamidine-base with 2 IM injections. Antimoniate of N. methylglucamine associated with IFNy could cure diffuse anergic cutaneous leishmaniasis (DACL). Associated BCG and leishmanian antigen with glucamine can also be of useful interest. Cl 1-3
Insects
W.R. Faber. Academic
and worms Medical
Centec
Anlsteniam,
The
Netherlands
Persistent insect bites are regularly seen in an out-patient department of Tropical Dermatology. Most patients are travellers who have visited a large variety of countries. More than one third of the patients were unaware that they had been bitten. Localization of the skin lesions is mostly on the legs and less frequently on the arms and the body. The clinical picture is that of, frequently excoriated, papules and also nodules or plaques. Lesions may persist for months, even more than one year, Secondary infection may occur and several patients had been treated already with antibiotics during their travel. Histopathology is mostly lymphocytic-histiocytic perivascular infiltrates with admixture of eosinophils in varying intensity. In a minority granuloma formation is seen. Eczematous changes are common. Therapy consists of local corticosteroid treatment, sometimes under hydrocolloid occlusion (Conttexte’) for several weeks. In a few cases oral prednisone treatment is indicated. Creeping eruption, due to infection with larvae of ancylostoma of dogs and cats, is a common imported skin disease. Due to the characteristic clinical picture this is in essence a clinical diagnosis. Treatment consists of tiabendazol cream or, in severe cases, oral albendazol.
demoloses
Cl l-4
Imported
mycotic
infections
G.E. PiCrard. LiPge, Belgium The European importation of foreign mycoses is a historical feature. One of the best examples is the spread of Trichophyton rubrum several decades ago. The current epidemiological situation indicates the emergence of fungal newcomers. Geoclimatic and social environments are the main factors influencing the nature of genuine exotic mycoses. With the ever growing travel opportunities, frequent immigration sollicitations and war-related movements of populations, the epidemiological risk for the importation of unusual fungal infections is increasing in Europe. Some of these diseases are transmissible to the local population of the new geographical location while others show no or little propensity for dissemination. A few dermatophyte species responsible for tinea capitis which were previously confined to remote geographical areas are now present in close communities of immigrants living in large European cities. Some systemic mycoses, such as those caused by Penicillium mameffei and Histoplasma capsulatum were previously prevalent in circumscribed regions of the world. Nowadays, they prevail in severely immuno-compromised patients worldwide. They are considered to be markers of AIDS. 1Cl l-5
Imported
dermatoses:
E. Nunzi, P Fiallo. Centro Morbo
di Hansen,
Genova,
di Riferinrento Italia
Leprosy Nazionale
per il
Migration has always been one the most important ways of transmission of infectious diseases. In Western Europe leprosy is almost exclusively represented by imported cases. For instance, 66 (69%) of the 96 new cases of leprosy diagnosed in Italy between 1990 and 1997 were seen in migrant workers and 25% in Italian citiziens living abroad. As a result leprosy is no longer limited to endemic areas but may occur in any part of Europe. The incidence of leprosy in Europe is very low compared to the number of immigrants from endemic regions. This is probably due to the efficacy of multidrug therapy in endemic countries. Furthermore most immigrants come from urban areas where the prevalence of leprosy is low compared to rural areas. How can leprosy be controlled in Europe? 1. By teaching medical workers, in particular dermatologists, the priciples for clinical diagnosis; 2. By setting up reference laboratoires to confirm the clinical diagnosis of leprosy; 3. By establishing specialized centers that can cope with the medical and social problems related to leprosy, such as treatment of the acute clinical complications prevention and correction of disabilities and social reintegration of cured individuals.