OBJECTIVE:This study aimed to determine the frequency of coinfections in leprosy patients and whether there is a relationship between the presence of coinfections and the development of leprosy reactional episodes.METHOD:A cross-sectional study based on an analysis of the medical records of the patients who were treated at the Leprosy Clinics of the Ribeirão Preto Medical School, University of São Paulo, was conducted from 2000 to 2010. Information was recorded regarding the age, sex, clinical status, WHO classification, treatment, presence of reactions and coinfections. Focal and systemic infections were diagnosed based on the history, physical examination, and laboratory tests. Multinomial logistic regression was used to evaluate the associations between the leprosy reactions and the patients' gender, age, WHO classification and coinfections.RESULTS:Two hundred twenty-five patients were studied. Most of these patients were males (155/225 = 68.8%) of an average age of 49.31±15.92 years, and the most prevalent clinical manifestation was the multibacillary (MB) form (n = 146), followed by the paucibacillary (PB) form (n = 79). Erythema nodosum leprosum (ENL) was more prevalent (78/122 = 63.9%) than the reversal reaction (RR) (44/122 = 36.1%), especially in the MB patients (OR 5.07; CI 2.86-8.99; p<0.0001) who exhibited coinfections (OR 2.26; CI 1.56-3.27; p<0.0001). Eighty-eight (88/225 = 39.1%) patients exhibited coinfections. Oral coinfections were the most prevalent (40/88 = 45.5%), followed by urinary tract infections (17/88 = 19.3%), sinusopathy (6/88 = 6.8%), hepatitis C (6/88 = 6.8%), and hepatitis B (6/88 = 6.8%).CONCLUSIONS:Coinfections may be involved in the development and maintenance of leprosy reactions.

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Healthy patient in which during ordinary examination a pulmonary schistosomotic nodule with an adult parasite, was detected 25 years far from endemic region and after specific treatment with oxamniquine. Clinically the nodule simulated neoplasia.

Resumo: A citologia de Tzanck consiste em método simples e confiável para o diagnóstico de dermatoses virais, parasitárias, autoimunes e tumorais. Para exemplificar o emprego do teste de Tzanck em lesões vési-co-bolhosas, um caso de pênfigo vulgar é descrito, cuja citologia e imunofluorescência direta, utilizando-se esfregaço coletado de lesão oral, confirmaram o diagnóstico de forma rápida e fácil. Palavras-chave: Citologia; Imunofluorescência; Pênfigo Abstract: Tzanck smears can be used for the diagnosis of cutaneous infections, autoimmune disorders and cutaneous tumors. To exemplify its use, we report a case of a female patient with pemphigus vulgaris whose diagnosis was confirmed by positive direct immunofluorescence and conventional cytology using smears obtained by scraping the cheek mucosa. Keywords: Cytology; Fluorescent antibody technique; Pemphigus ©2009 by Anais Brasileiros de Dermatologia COMUNICAÇÃOA citologia, que estuda as células individuais, suas características intrínsecas e suas funções, é uma ciência relativamente nova. George Papanicolaou é considerado o pai da citologia esfoliativa; porém, em 1947, foi Tzanck quem utilizou pela primeira vez a citologia para diagnóstico, empregando-a em dermatoses vésico-bolhosas, particularmente no herpes simplex. Os dermatologistas pouco têm utilizado a citodiagnose no seu cotidiano, embora, em mãos experientes, o exame de esfregaço cutâneo ou de mucosa possa ser simples, rápido, barato e confiável para o diagnóstico de muitas doenças dermatológicas, das mais variadas etiologias. Seu uso tem se restringido à pesquisa de células escamosas multinucleadas sugestivas de inclusão viral em lesões de mucosa oral ou quando se suspeita de eczema vacinatum.