MARIA ANGELA BIANCONCINI TRINDADE
Projetos de Pesquisa
Unidades Organizacionais
LIM/56 - Laboratório de Investigação em Dermatologia e Imunodeficiências, Hospital das Clínicas, Faculdade de Medicina
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- Trichoscopic findings of eyebrow alopecia in patients with multibacillary leprosy(2019) DOCHE, Isabella; TOSTI, Antonella; NETO, Cyro F.; TRINDADE, Maria Angela B.; RIVITTI-MACHADO, Maria Cecilia M.; AVANCINI, Joao
conferenceObject Necrotisans erythema nodosum leprosum with systemic manifestations(2018) ISHIY, Patricia; TRINDADE, Maria Angela; AVANCINI, Joao; PAZZINI, Renato; JORGE, Lecticia; SOTTO, Mirianarticle 1 Citação(ões) na Scopus Severe adverse reactions to multidrug therapy for leprosy, registered in tertiary services between 2012 and 2017 in Brazil(2018) PANTE, Cristina Castro; COELHO, Silvio Caetano; CARELLI, Luzia; AVANCINI, Joao; TRINDADE, Maria Angela BianconciniObjectives: This work aims to determinate the main severe adverse reactions to multidrug therapy (MDT), as well as the characteristics of the patients who had them and the period when they were more prevalent. Results: Of the 158 patients undergoing treatment for leprosy in the period 2012-2017, 22 (13.9%) were using substitutive treatment for leprosy and presented criteria to enter this study. Adverse reactions were more frequent in women (59.1%), above 45 years age and during second month of treatment. Dapsone was the most frequently implied drug (86.4%), and hemolytic anemia was the main reaction (72.7%). Conclusion: Severe adverse reaction to dapsone is common in MDT, mainly due to hemolytic anemia.- Ulcers in leprosy patients, an unrecognized clinical manifestation: a report of 8 cases(2019) MIYASHIRO, Denis; CARDONA, Carolina; VALENTE, Neusa Yuriko Sakai; AVANCINI, Joao; BENARD, Gil; TRINDADE, Maria Angela BianconciniBackground Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae. It is a polymorphic disease with a wide range of cutaneous and neural manifestations. Ulcer is not a common feature in leprosy patients, except during reactional states, Lucio's phenomenon (LP), or secondary to neuropathies. Cases presentation We report eight patients with multibacillary leprosy who presented specific skin ulcers as part of their main leprosy manifestation. Ulcers were mostly present on lower limbs (eight patients), followed by the upper limbs (three patients), and the abdomen (one patient). Mean time from onset of skin ulcers to diagnosis of leprosy was 17.4 months: all patients were either misdiagnosed or had delayed diagnosis, with seven of them presenting grade 2 disability by the time of the diagnosis. Reactional states, LP or neuropathy as potential causes of ulcers were ruled out. Biopsy of the ulcer was available in seven patients: histopathology showed mild to moderate lympho-histiocytic infiltrate with vacuolized histiocytes and intact isolated and grouped acid-fast bacilli. Eosinophils, vasculitis, vasculopathy or signs of chronic venous insufficiency were not observed. Skin lesions improved rapidly after multidrug therapy, without any concomitant specific treatment for ulcers. Conclusions This series of cases highlights the importance of recognizing ulcers as a specific cutaneous manifestation of leprosy, allowing diagnosis and treatment of the disease, and therefore avoiding development of disabilities and persistence of the transmission chain of M. leprae.
- Histoid leprosy: clinical and histopathological analysis of patients in follow-up in University Clinical Hospital of endemic country(2018) CANUTO, Maria J. M.; YACOUB, Carolina R. D.; TRINDADE, Maria A. B.; AVANCINI, Joao; PAGLIARI, Carla; SOTTO, Mirian N.BackgroundHistoid leprosy (HL) is a rare form of lepromatous leprosy, characterized by hyperchromic indurated nodules above normal skin. Its main histopathological aspect is spindle cells. Because it may simulate other aspects, such as dermatofibroma and neurofibroma, histoid leprosy poses itself as a diagnostic challenge. MethodsThis is a retrospective study with all patients having been selected from the leprosy clinic of the Hospital das Clinicas da Universidade de SAo Paulo from 2006 to 2016. ResultsThere were 12 patients in this study, eight in the histoid group and four in the lepromatous leprosy group. The prevalence of HL was 1.12% in all leprosy subjects. All individuals from HL group were de novo cases, and the histopathological analysis of skin lesions presented spindle cells generating a storiform pattern. Immunohistochemistry for CD68, vimentin, and anti-BCG were positive in all 12 cases. Factor XIIIa was visualized only in the papillary dermis, and S100 protein was negative in all biopsies. Smooth-muscle actin was present in 62.5% of the HL samples. ConclusionThe prevalence of HL was similar to previous reports. However, all histoid patients were de novo cases, differing from published studies. Fusocellular macrophage transformation could be explained by the differences in cytoskeleton proteins expressed in histoid lesions in comparison to other leprosy variants, with emphasis on vimentin and smooth muscle actin.
- Development of Type 2, But Not Type 1, Leprosy Reactions is Associated with a Severe Reduction of Circulating and In situ Regulatory T-Cells(2016) VIEIRA, Ana Paula; TRINDADE, Maria Angela Bianconcini; PAGLIARI, Carla; AVANCINI, Joao; SAKAI-VALENTE, Neusa Yurico; DUARTE, Alberto Jose da Silva; BENARD, GilLeprosy is frequently complicated by the appearance of reactions that are difficult to treat and are the main cause of sequelae. We speculated that disturbances in regulatory T-cells (Tregs) could play a role in leprosy reactions. We determined the frequency of circulating Tregs in patients with type 1 reaction (T1R) and type 2 reaction (T2R). The in situ frequency of Tregs and interleukin (IL)-17, IL-6, and transforming growth factor beta (TGF)-beta-expressing cells was also determined. T2R patients showed markedly lower number of circulating and in situ Tregs than T1R patients and controls. This decrease was paralleled by increased in situ IL -17 expression but decreased TGF-beta expression. Biopsies from T1R and T2R patients before the reaction episodes showed similar number of forkhead box protein P3 + (FoxP3+) and IL-17+ cells. However, in biopsies taken during the reaction, T2R patients showed a decrease in Tregs and increase in IL-17+ cells, whereas T1R patients showed the opposite: Tregs increased but IL-17+ cells decreased. We also found decreased expansion of Tregs upon in vitro stimulation with Mycobacterium leprae and a trend for lower expression of FoxP3 and the immunosuppressive molecule cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) in T2R Tregs. Our results provide some evidence to the hypothesis that, in T2R, downmodulation of Tregs may favor the development of T-helper -17 responses that characterize this reaction.
- Leprosy elimination - Still a long way to go(2019) AVANCINI, Joao; TRINDADE, Maria Angela Bianconcini; SANCHES, Jose Antonio
conferenceObject Erythema nodosum leprosum with facial and trigeminal nerve involvement(2017) ROMERO-SANDOVAL, Karina; YACOUB, Carolina; PAZZINI, Renato; AVANCINI, Joao; TAKATSU, Tania; BORDALO, Marcelo; BIANCONCINI, Maria Angela- Expansion and suppressive capacity of regulatory T cells isolated from patients across the leprosy spectrum: a pilot study(2020) CARDONA, Carol; VIEIRA, Ana P.; AVANCINI, Joao; DUARTE, Alberto J. S.; TRINDADE, Maria Angela B.; BENARD, GilKnowledge of the role of Tregs in the immunopathogenesis of the different clinical outcomes within the leprosy spectrum remains limited due to the lack of studies directly assessing their suppression capacity. We thus tested a protocol to expand Tregs from the peripheral blood of patients across the leprosy spectrum and analyzed their suppressive capacity in autologous TCD4+ responses. Results of these pilot assays show that Tregs can be expanded and exert suppressive capacity, but also that their rate of expansion and suppressive capacity are influenced by the patient's clinical classification, suggesting that they possibly retain some in vivo characteristics.