Doença de Jorge Lobo entre os índios Caiabi: epidemiologia. Análise histopatológica e imuno-histoquímica nas diferentes apresentações clínicas
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Data
2014-03-31
Autores
Floriano, Marcos César [UNIFESP]
Orientadores
Tomimori, Jane [UNIFESP]
Tipo
Tese de doutorado
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Introdução: A doença de Jorge Lobo (DJL) é infecção fúngica crônica de acometimento da pele e há uma prevalência inusitada entre os índios Caiabi, povo que habita a região central do Brasil.
Objetivos: 1) Descrever e revisar a epidemiologia da DJL entre os índios Caiabi desde os primeiros relatos até o presente momento. 2) Avaliar e comparar os aspectos histopatológicos e a resposta imune tecidual nas diferentes lesões cutâneas de um mesmo doente, assim como nos nódulos de doentes com formas localizadas e disseminadas.
Métodos: 1) Realizada revisão da literatura indexada, de livros e registros de todos os casos da DJL entre os índios Caiabi, desde os primeiros relatos até os dias de hoje. 2) Numa amostra de 24 índios Caiabi com DJL, foram realizados os exames histopatológicos e imunohistoquímicos com marcadores de respostas imunológicas em amostras de diferentes lesões cutâneas num mesmo doente e de nódulos de doentes com formas localizadas e disseminadas.
Resultados: 1) O número total de casos da DJL entre os índios Caiabi, desde os primeiros relatos até o presente momento, é de 63. A forma localizada foi significantemente mais presente no sexo feminino e a forma disseminada significantemente mais presente no sexo masculino. 2) Nas diferentes lesões cutâneas (nódulo, úlcera e atrofia), os dados que apresentaram significância estatística (p<0,05) foram: maior presença de células CD68+, CD3+, CD54+ e maior número de fungos no nódulo que na atrofia; maior presença de células CD3+, CD8+, CD20+ e CD25+ na úlcera que na atrofia; maior presença de células CD25+ na úlcera que no nódulo; maior presença de células CD8+ nas formas localizadas que nas formas disseminadas.
Discussão e Conclusões: 1) A DJL apresenta uma única e impressionante prevalência entre os índios Caiabi, além de um comportamento distinto entre os sexos, predominando formas disseminadas nos homens e localizadas nas mulheres. 2) A atrofia parece representar uma regressão da atividade da doença e a úlcera parece representar maior atividade imunológica de padrão Th1. Há maior expressão de linfócitos T CD8+ nas formas localizadas, sendo uma das possíveis diferenças de resposta imunológica do hospedeiro que justificam essa apresentação clínica em alguns doentes.
Introduction: The lobomycosis is a chronic fungal infection that affects the skin. It has been a peculiar prevalence among the Brazilian Caiabi Indians from Central Brazil. Objectives: 1) To make a description and a review of the epidemiology of the lobomycosis among Caiabi Indians from the first report to date. 2) To make an evaluation and comparison of the histopathologic and local immune host aspect by immunohistochemistry in the different cutaneous lesions in the same patient as well as in the patients’ nodules with the localized and disseminated forms. Methods: 1) We performed an analysis in the indexed literature, books and registers of all cases of lobomycosis among the Caiabi Indians from the first report to date. 2) In 24 cutaneous samples of Caiabi Indians with lobomycosis, it was performed the histopathologic and immunohistochemical technics with immunological markers in different cutaneous lesions in the same patient and in the patients’ nodules with the localized and disseminated forms. Results: 1) There are 63 lobomycosis’ cases among the Caiabi Indians from the first report to date. The localized form of the disease was more present in Caiabi female. However, the disseminated form was more present in Caiabi male (p<0,05). 2) Among the different cutaneous clinical presentations (nodules, ulcers and atrophic lesions), the data with statistical significance were: quantitative more immunolabelling of the CD68+, CD3+ CD54+ cells and fungi in nodules than in atrofic lesions; quantitative more immunolabelling of the CD3+, CD8+, CD20+ and CD25+ cells in ulcers than in atrofic lesions; quantitative more immunolabelling of the CD25+ cells in ulcesr than in nodule lesions; quantitative more immunolabelling of the CD8+ cells in localized forms. Discussion and Conclusions: 1) The lobomycosis shows a singular and amazing prevalence among the Caiabi Indians. In addition, there is a distinct presentation among males and females, with the predominance of disseminated forms in males and the localized forms in females. 2) The atrofic lesions may represent a less activity of the disease. The ulcer lesions may represent a great Th1 immunologic activity. There is a great immunolabelling expression of CD8+T lymphocytes in localized forms. Consequently, this expression may represent a one of the differences of host immune responses to explain this presentation in some cases.
Introduction: The lobomycosis is a chronic fungal infection that affects the skin. It has been a peculiar prevalence among the Brazilian Caiabi Indians from Central Brazil. Objectives: 1) To make a description and a review of the epidemiology of the lobomycosis among Caiabi Indians from the first report to date. 2) To make an evaluation and comparison of the histopathologic and local immune host aspect by immunohistochemistry in the different cutaneous lesions in the same patient as well as in the patients’ nodules with the localized and disseminated forms. Methods: 1) We performed an analysis in the indexed literature, books and registers of all cases of lobomycosis among the Caiabi Indians from the first report to date. 2) In 24 cutaneous samples of Caiabi Indians with lobomycosis, it was performed the histopathologic and immunohistochemical technics with immunological markers in different cutaneous lesions in the same patient and in the patients’ nodules with the localized and disseminated forms. Results: 1) There are 63 lobomycosis’ cases among the Caiabi Indians from the first report to date. The localized form of the disease was more present in Caiabi female. However, the disseminated form was more present in Caiabi male (p<0,05). 2) Among the different cutaneous clinical presentations (nodules, ulcers and atrophic lesions), the data with statistical significance were: quantitative more immunolabelling of the CD68+, CD3+ CD54+ cells and fungi in nodules than in atrofic lesions; quantitative more immunolabelling of the CD3+, CD8+, CD20+ and CD25+ cells in ulcers than in atrofic lesions; quantitative more immunolabelling of the CD25+ cells in ulcesr than in nodule lesions; quantitative more immunolabelling of the CD8+ cells in localized forms. Discussion and Conclusions: 1) The lobomycosis shows a singular and amazing prevalence among the Caiabi Indians. In addition, there is a distinct presentation among males and females, with the predominance of disseminated forms in males and the localized forms in females. 2) The atrofic lesions may represent a less activity of the disease. The ulcer lesions may represent a great Th1 immunologic activity. There is a great immunolabelling expression of CD8+T lymphocytes in localized forms. Consequently, this expression may represent a one of the differences of host immune responses to explain this presentation in some cases.
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Citação
FLORIANO, Marcos César. Doença de Jorge Lobo entre os índios Caiabi: epidemiologia. Análise histopatológica e imuno-histoquímica nas diferentes apresentações clínicas. 2014.154 f. Tese (Doutorado em Ciências) – Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 2014.