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Browsing by Author "Vieira, MR"

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  • Hansen's Disease in Portugal: Multibacillary Patients Treated Between 1988 and 2003
    Publication . Medeiros, S; Catorze, MG; Vieira, MR
    BACKGROUND: There is an estimate low incidence of patients with Hansen's disease in Portugal. Following the 1982 World Health Organization (WHO) recommendations, extended multidrug therapy (MDT) was started for multibacillary (MB) patients. Patients were then treated with rifampicine (RFP), clofazimine (CLF) and dapsone (DDS) for a minimum of 2 years or until smear negativity. The aim of this study was to evaluate MDT efficacy in our patient population. METHODS: Retrospective and descriptive study of 102 MB patients who underwent MDT from 1988 to 2003. RESULTS: The number of new MB patients has gradually increased since 1960, the first year of our consultation, due mostly to a rise in imported cases. Overall, 34% of the subjects were immigrants, mainly from former Portuguese Colonies. Forty-six patients had previously received monotherapy with DDS (mean duration of this treatment, 22 years). Relapse after MDT occurred in 9 cases (8.8%), but importantly, all relapsed cases were smear negative at least on one occasion after the end of treatment, suggesting these were true relapses rather than treatment failures. CONCLUSIONS: Despite the 2-year WHO-MDT regimen, patients with MB disease clearly face the possibility of relapse. We propose that any reduction in the duration of therapy such as the recently proposed 6-month standard MDT is likely to increase the relapse rate even further. Important issues for future consideration are the needs to identify those at risk of relapse and in need of alternative antimicrobial treatment with a prolonged clinical follow-up.
    2009-01Journal article Open access Show more
  • Phaeohyphomycosis Caused by Alternaria Infectoria Presenting as Multiple Vegetating Lesions in a Renal Transplant Patient
    Publication . Cunha, D; Amaro, C; Vieira, MR; Martins, ML; Maduro, AP; Inácio, J; Afonso, A; Marques Pinto, G; Cardoso, J
    The genus Alternaria is one of the most common black moulds and appears to be increasing as a causative agent of subcutaneous phaeohyphomycosis, particularly among immunosuppressed patients. A 53-year-old patient who had received a kidney transplant presented with multiple verrucous lesions on the distal extremities. Positive histopathology and cultures, in addition to rDNA ITS region sequencing, identified the fungal isolate as Alternaria infectoria. Oral itraconazole was administered for 10 months. A follow-up at 15 months demonstrated no signs of infection. Clinical manifestations of cutaneous alternariosis vary significantly and only a few cases have been described in the literature. Although optimal treatment options remain controversial, this case of phaeohyphomycosis was successfully treated with itraconazole monotherapy.
    2012Journal article Open access Show more