A Case Non-Autochthonous Canine Visceral Leismaniosis in the Municipality of Guarulhos, São Paulo, Brazil

A male canine, two years old, with no known breed, with a history of diarrhea and ticks, was submitted to a private veterinary clinic in the City of Guarulhos, São Paulo State, Brazil: presenting weight loss, alopecia and intense pruritus. The owner reported that the dog was a native of the City of Votuporanga, São Paulo State. Blood samples were collected for blood counts and biochemical measurements, and rapid tests were performed with commercial kits for the detection of Ehrlichia canis, Anaplasma spp., Borrelia burgdorferi and Canine distemper. Due to the hematological and biochemical changes, the negative results, and the origin of the animal, it was decided to perform a rapid test for leishmaniasis, where this test presented a positive result, later confirmed by Polymerase Chain Reaction. The Leishmaniose continue advancing, being able to settle in non-endemic areas.

The Role of Atorvastatin in Management of Eruptive Xanthoma on a Boy: A Case Report

Background: Eruptive xanthoma is a benign skin lesion caused by the accumulation of cholesterol and triglycerides in the skin's dermis. Xanthoma can be an early clinical manifestation of systemic diseases such as dyslipidemia, cardiovascular disease, diabetes mellitus. Clinical presentation varies from asymptomatic skin lesions to intense pruritus and tenderness. Aim: This study aims that oral atorvastatin is effective in treating a child with eruptive xanthoma. Case report: A three-year-old boy with an 8.4 kg body weight and 82.5 cm height came to the hospital with the chief complaint of small yellowish-white papules and nodes, discrete, 2-5 mm in size, painless on pressing, itchy, scattered, mainly in the lower extremity around the buttocks. On laboratory examination, Hb 11.5 g/dL, leukocyte 9,900/ul, platelet 413,000/uL, blood glucose 66 mg/dL. Further evaluation revealed total cholesterol 814 mg/dL, LDL 970 mg/dL, HDL 341 mg/dl, triglycerides 621 mg/dL; there is no evidence of familial hypercholesterolemia. The diagnosis is eruptive xanthoma. After starting treatment with atorvastatin 0.2 mg/kg body weight/day in one dose for six months, his cutaneous lesions gradually subsided and significantly decreased cholesterol, LDL, HDL, and triglyceride levels. Conclusion: Early therapy with atorvastatin will reduce the morbidity and mortality of eruptive xanthoma.

Case Report: Successful Treatment of Sarcoptic Mange in European Camelids

Introduction: Members of the Camelidae family are very adaptable mammals, originating from South America. More recently, they have become popular in Europe as pets or wool production farm animals. Their dermatological problems refer mainly to mange, of which sarcoptic mange represent the most clinically relevant form. There is a wide range of molecules effective against sarcoptic mange, but the treatment is very challenging due to the lack of efficiency and absorption.Methods: Two cases from two different animal populations were described. A female alpaca from Romania with dermatological problems on the ears and two adult llamas, from Italy, both with intense pruritus. Combined treatment with amitraz and subcutaneous eprinomectin was administered for the alpaca, and 2% moxidectin was given to the llamas.Results: In both cases, the mites were morphologically identified as Sarcoptes scabiei. For the alpaca, negative scrapings were found only after 8 weeks of combined treatment. For the llamas, after four doses of subcutaneous moxidectin, no mites were detected in scrapings and lively hair regrowth of previously alopecic areas was visible.Conclusion: This paper aimed to present two clinical scenarios of sarcoptic mange in camelids, successfully treated with a combination of ectocides (topical amitraz and subcutaneous eprinomectin) and 2% subcutaneous moxidectin, respectively.

Sarcoptic mange outbreak decimates South American camelid populations in San Guillermo National Park, Argentina

Sarcoptic mange epidemics can devastate wildlife populations. In 2014, mange was first detected in vicuña ( Vicugna vicugna ) and guanaco ( Lama guanicoe ) in San Guillermo National Park (SGNP), Argentina. This study characterized the potential source and the impacts of the outbreak in 2017–2019. Transect surveys indicated a sharp decrease in the density of live vicuña and guanaco by 68% and 77%, respectively, from May 2017 to June 2018. By April 2019 no vicuña or guanaco were recorded on transect surveys, suggesting a near-extinction at the local level. Clinical signs consistent with mange (e.g. intense pruritus, hyperkeratosis, alopecia) were observed in 24% of live vicuña (n = 478) and 33% of live guanaco (n = 12) during surveys, as well as in 94% of vicuña carcasses (n = 124) and 85% of guanaco carcasses (n = 20) opportunistically examined during the study period. Histological examination (n = 15) confirmed sarcoptic mange as the cause of the cutaneous lesions. Genetic characterization revealed that Sarcoptes scabiei recovered from seven vicuña (n­ = 13) and three guanaco (n = 11) shared the same genotype, which is consistent with a single source and recent origin of the epidemic. A governmental livestock incentive program introduced llama ( Lama glama ) in areas adjacent to SGNP in 2009, some of which reportedly had alopecic scaling consistent with sarcoptic mange. We hypothesize that the introduction of mange-infected llama may have triggered the outbreak in wild camelids which has now put them at a high risk of local extinction. This unprecedented event highlights that the accidental introduction of disease may be underestimated at the onset yet can have devastating effects on native ungulate populations with potentially profound effects at the community and ecosystem levels.

Intrahepatic Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a rare but potentially serious complication of pregnancy, the main symptom of which is intense pruritus with elevated serum levels of bile acids. The elevated serum bile acid concentration is regarded as a predictor for poor perinatal outcome including intrauterine death. Ursodeoxycholic acid (UDCA) has become established as the treatment of choice in clinical management to achieve a significant improvement in symptoms and reduce the cholestasis. Pregnant women with severe intrahepatic cholestasis should always be managed in a perinatal centre with close interdisciplinary monitoring and treatment involving perinatologists and hepatologists to minimise the markedly increased perinatal morbidity and mortality as well as maternal symptoms.

Pacific-Ciguatoxin-2 and Brevetoxin-1 Induce the Sensitization of Sensory Receptors Mediating Pain and Pruritus in Sensory Neurons

Ciguatera fish poisoning (CFP) and neurotoxic shellfish poisoning syndromes are induced by the consumption of seafood contaminated by ciguatoxins and brevetoxins. Both toxins cause sensory symptoms such as paresthesia, cold dysesthesia and painful disorders. An intense pruritus, which may become chronic, occurs also in CFP. No curative treatment is available and the pathophysiology is not fully elucidated. Here we conducted single-cell calcium video-imaging experiments in sensory neurons from newborn rats to study in vitro the ability of Pacific-ciguatoxin-2 (P-CTX-2) and brevetoxin-1 (PbTx-1) to sensitize receptors and ion channels, (i.e., to increase the percentage of responding cells and/or the response amplitude to their pharmacological agonists). In addition, we studied the neurotrophin release in sensory neurons co-cultured with keratinocytes after exposure to P-CTX-2. Our results show that P-CTX-2 induced the sensitization of TRPA1, TRPV4, PAR2, MrgprC, MrgprA and TTX-r NaV channels in sensory neurons. P-CTX-2 increased the release of nerve growth factor and brain-derived neurotrophic factor in the co-culture supernatant, suggesting that those neurotrophins could contribute to the sensitization of the aforementioned receptors and channels. Our results suggest the potential role of sensitization of sensory receptors/ion channels in the induction or persistence of sensory disturbances in CFP syndrome.

HCV poly U/UC sequence–induced inflammation leads to metabolic disorders in vulvar lichen sclerosis

Vulvar lichen sclerosis (VLS) is a dermatologic disorder that affects women worldwide. Women with VLS have white, atrophic papules on the vulva. They suffer from life-long intense pruritus. Corticosteroids are the first-line of treatments and the most effective medicines for VLS. Although VLS has been speculated as an autoimmune disease for a long time, its pathogenesis and the molecular mechanism is largely unknown. We performed a comprehensive multi-omics analysis of paired samples from VLS patients as well as healthy donors. From the RNA-seq analysis, we found that VLS is correlated to abnormal antivirus response because of the presence of Hepatitis C Virus poly U/UC sequences. Lipidomic and metabolomic analysis revealed that inflammation-induced metabolic disorders of fatty acids and glutathione were likely the reasons for pruritus, atrophy, and pigment loss in the vulva. Thus, the present study provides an initial interpretation of the pathogenesis and molecular mechanism of VLS and suggests that metabolic disorders that affect the vulva may serve as therapeutic targets for VLS.

Comparative Efficacy of Fipronil, Ivermectin and Clove Oil (Eugenia caryophyllata) against Psoroptes cuniculi Mites in Rabbits (Oryctolagus cuniculus)

Background: The present study was conducted to evaluate the therapeutic efficacy of fipronil, ivermectin and clove oil against frequently reported Psoroptes cuniculi mites which are responsible for causing intense pruritus and scab formation on skin, ear pinna and ear canal in domestic rabbits (Oryctolagus cuniculus). Methods: The rabbits were divided into 3 groups viz. A, B and C each having 10 rabbits. These groups were topically treated with fipronil, ivermectin and clove oil on days 0, 7, 14 and 21. Pre and post treatment evaluations were made on the basis of clinical improvement and microscopic examination of skin scrapings in each group. Conclusion: Results revealed that all 3 drugs were effective against P. cuniculi; but ivermectin led recovery was quicker than rest of the two drugs. All three groups were free of lesions and mites on day 21 of treatment.

Instagram Content Addressing Pruritic Urticarial Papules and Plaques of Pregnancy: Observational Study

Background Pruritic urticarial papules and plaques of pregnancy (PUPPP) is the most commonly diagnosed pregnancy-specific dermatosis. It presents with intense pruritus and can be difficult to manage, which encourages mothers to look to social media for camaraderie and advice. Objective This study aimed to characterize the sources and thematic content of Instagram posts in order to define influential groups of users. Our goal was to determine the status of online discourse surrounding PUPPP and elucidate any potential space for health care provider intervention via creation of Instagram accounts dedicated to information dissemination for patient populations. Methods Three hashtag categories were selected (#PUPPP, #PUPPPs, and #PUPPPrash), and the top public posts from each were analyzed and organized by source and by thematic content. The numbers of likes and comments were also recorded. Results Among the top 150 posts in each hashtag category, only 428 posts in total were eligible for this analysis. Majority (316/428, 73.8%) of posts were created by mothers who experienced PUPPP. These posts were testimonial accounts in nature. A small fraction of posts (14/428, 3.3%) were generated by physician accounts. Posts from blogs with extensive followings garnered the most attention in the form of likes and comments. Conclusions Mothers experiencing PUPPP comprised the majority of accounts posting under the hashtags selected. The most common themes included pictures of the rash and personal testimonies. Posts under blog posts received the most likes and comments on average. There is space for physician and health care specialists to improve their social media presence when it comes to discourse surrounding PUPPP. Patients are seeking out communities on social media, like Instagram, in order to have questions answered and obtain advice on management. Accounts with large followings tend to have more likes and more comments, which encourages information dissemination and awareness. Thus, we suggest that physicians create content and potentially partner with blog-type accounts to improve outreach.