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      Phthiriasis palpebral: diagnóstico y tratamiento Translated title: Phthiriasis palpebrarum: diagnosis and treatment

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          Abstract

          La Phthiriasis palpebral, parasitación de las pestañas por Phtirus pubis, es una causa poco frecuente de blefaroconjuntivis, por lo que su diagnóstico puede pasarnos fácilmente desapercibido. Ante un paciente con Phthiriasis palpebral hemos de descartar la presencia de parásitos en otras localizaciones de su cuerpo e investigar la más que probable asociación con otras enfermedades de transmisión sexual. En niños se nos plantea además un importante reto medico-legal ya que puede tratarse de un caso de abuso sexual. En los últimos años hemos detectado un aumento en el número de casos diagnosticados en nuestro servicio. En el presente trabajo revisamos las características epidemiológicas, clínicas y diagnósticas de la phthiriasis palpebral así como las distintas medidas terapeúticas destinadas a la eliminación del parásito y a la prevención de infestaciones.

          Translated abstract

          Phthiriasis palpebrarum, caused by Phthirus pubis, is an uncommon cause of blepharoconjunctivitis; therefore, this condition is easily misdiagnosed. When diagnosed, genital involvement must be ruled out. Association with other venereal diseases is common. Affected children must be searched for sexual abuse. The number of diagnosed patients in our department has increased in recent years. We review the epidemiological, clinical and diagnostic features of phthriasis palpebrarum as well as the different treatment options to eradicate the parasite and to prevent infestations.

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          Most cited references78

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          Scabies and pediculosis.

          O Chosidow (2000)
          Scabies and pediculosis are ubiquitous, contagious, and debilitating parasitic dermatoses. They have been known since antiquity and are distributed worldwide. Clusters of infestation occur-for example, scabies affecting immunocompromised individuals or patients and staff in hospitals and nursing homes for the elderly, and pediculosis affecting schoolchildren or homeless people. Associations with other disorders are common: infections with human T-cell leukaemia/lymphoma virus I (HTLV-I) and HIV are associated with scabies, and trench fever and exanthematous typhus with pediculosis. Specific forms of scabies, including bullous scabies or localised crusted scabies, may be misdiagnosed. Moreover, definitive parasitic diagnosis can be difficult to obtain, and the value of new techniques remains to be confirmed. Difficulties in management have returned scabies and pediculosis to the limelight.
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            Uveitis and erythema nodosum in inflammatory bowel disease: clinical features and the role of HLA genes.

            There are few systematic studies on the natural history or immunogenetic associations of erythema nodosum (EN) or ocular inflammation in inflammatory bowel disease (IBD), but they are reportedly more common in patients with other extraintestinal manifestations (EIMs), particularly arthritis. Immunogenetic associations have previously been described in IBD arthritis and in EN associated with sarcoidosis. This study examined the clinical features and HLA-B, DR, and tumor necrosis factor alpha (TNF-alpha) associations of ocular inflammation and EN and their clinical and immunogenetic relationship to arthritis in IBD. Details of EN and ocular inflammation were gathered by case-note review and questionnaire in 976 ulcerative colitis patients and 483 Crohn's patients. Sequence-specific PCR typing for polymorphisms in HLA-B, DR, and TNF-alpha was performed in 39 EN and 40 ocular patients. Results were compared with 490 IBD controls without EIMs, 38 patients with type 1 and 31 with type 2 peripheral arthritis, and 16 AS patients. EN and ocular inflammation were more common in women, were associated with IBD relapse, and recurred in approximately 30% of patients. They occurred more commonly with arthritis and AS than expected by chance. Ocular inflammation was strongly associated with HLA-B*27, B*58, and HLA-DRB1*0103. There is a weak association between EN and HLA-B*15 but a strong association with the -1031 TNF-alpha. EN, uveitis, and arthritis associated with IBD occur together commonly. They are associated with genes in the HLA region, and linkage disequilibrium between these genes may account for the clinical picture of overlapping but independent clinical manifestations.
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              Clinical phenotype is related to HLA genotype in the peripheral arthropathies of inflammatory bowel disease.

              The detection of phenotype-determining genes as opposed to disease susceptibility genes requires precise phenotypic characterization of patients. Peripheral arthropathies in inflammatory bowel disease (IBD) are well recognized and are classified with the HLA-B*27-related spondyloarthropathies by the European Spondyloarthropathy Study Group. However, previous HLA studies in IBD have only shown this association with axial disease rather than peripheral arthropathy. We recently reported a clinical classification that describes 2 types of peripheral arthropathy, distinguished by their natural history and articular distribution. We now report the results of immunogenetic studies in these patients and compare them with other spondyloarthropathies. IBD patients with type 1 (n = 57) and type 2 (n = 45) peripheral arthropathy were identified by case note review and questionnaire. Patients and 603 controls from Oxfordshire were assigned HLA-A, -B, -C, -DR, and -DQ genotypes by sequence-specific primer polymerase chain reaction. Patient results were compared with controls (corrected for multiple comparisons), then with each other in light of existing hypotheses. The results were compared with those of a cohort of 30 patients with postenteric reactive arthritis (ReA) and 16 patients with IBD-associated ankylosing spondylitis (IBD-AS). Type 1 arthropathy was associated with HLA-DRB1*0103 (DR103; a rare subtype of DR1) in 33% (P < 0.0001; relative risk [RR], 12.1), B*35 in 30% (P = 0.01; RR, 2.2), and B*27 in 26% (P = 0. 001; RR, 4.0). In contrast, type 2 was associated with HLA-B*44 in 62% (P = 0.01; RR, 2.1). Similar significant associations to type 1 arthropathy were found in ReA, except that the HLA-B*27 association was significantly stronger and an association was found with DRB1*0101 (DR1) in 43% (P = 0.001; RR, 2.2). IBD-AS was associated only with HLA-B*27 and DRB1*0101. These data suggest that the clinical classification into type 1 and type 2 arthropathies describes immunogenetically distinct entities and establish that in polygenic disorders, genes may determine clinical phenotype without conferring overall disease susceptibility (in this case, HLA genes). Type 1 arthropathy is clinically and immunogenetically similar to the spondyloarthropathies, but different HLA associations may define phenotypically distinct groups. Type 2 arthropathy has different HLA associations and may have a different etiology. Further studies are now required to confirm these associations and to elucidate the different pathogenetic mechanisms.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                aseo
                Archivos de la Sociedad Española de Oftalmología
                Arch Soc Esp Oftalmol
                Sociedad Española de Oftalmología (, , Spain )
                0365-6691
                July 2003
                : 78
                : 7
                : 365-374
                Affiliations
                [01] Madrid orgnameHospital Central de Cruz Roja España
                Article
                S0365-66912003000700005
                10.4321/s0365-66912003000700005
                405cd2b8-0c06-4327-af87-4fce53f972b4

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 30 July 2003
                : 25 June 2003
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 57, Pages: 10
                Product

                SciELO Spain


                Phthriasis palpebral,Phthirus pubis,pediculosis,blefaritis,Phthriasis palpebrarum,blepharitis

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