General Coordinator Human Herpesvirus-8 and Kaposi Sarcoma Working Group Instituto de Medicina Tropical "Alexander von Humboldt" Universidad Peruana Cayetano Heredia, Lima - Peru
Abstract: Classic Kaposi s sarcoma (KS) affects lower extremities in older adults, showing a progressive, benign course. It can also involve oral mucosa and gastrointestinal tract with a lower frequency. The involvement of internal organs and lymph nodes is rare, and its primary compromise is even more uncommon. We report an unusual presentation of classic KS in the lymph nodes of three patients. A 46 years old male had a primary involvement of an inguinal lymph node. Dermal involvement appeared one year later. A 58years old male and a 76years old female with simultaneous dermal and lymph node involvement. We conclude that the presence of classic KS in our region is more common than previously considered. Moreover, it must be emphasized that KS in lymph nodes can affect HIV-negative patients or patients without any associated immune deficiency.
Abstract: Serum samples from 128 blood donors were tested for antibodies specific for human herpesvirus-8 by an immunofluorescence assay that detects antibodies against mainly lytic antigens. An overall seroprevalence of 56.25% was found (male donors, 54.68%; female donors, 57.11%). These findings indicate that human herpesvirus-8 infection is hyperendemic in Peruvian blood donors.
Abstract: Traditionally, classic KS lesions have a general distribution, often involving the skin of the feet and legs, and to a lesser extent, that of the hands, arms, and trunk. Oral involvement is a rare manifestation. Initial oral involvement is an even rarer occurrence. We report two unusual cases of classic KS presenting in the oral cavity of two patients from indigenous origin; the first patient with primary oral KS lesion on the hard palate, with no other signs of the condition in any other region of the body; the second patient with generalized dermal KS lesions with lymph node and lower lip involvement. In conclusion, clinicians and pathologists should be aware of the typical clinical, gross, and histologic features of KS. Moreover, we would like to emphasize that oral KS may affect patients without AIDS or exposure to immunosuppression. The awareness of oral classic KS as a diagnostic possibility is important in the work-up of vascular lesions in the oral cavity of non-immunosuppressed individuals.
Abstract: Background: Prevalence of the metabolic syndrome has been described in populations with ethnic and cultural differences. The aim of this study was to determine the prevalence of the metabolic syndrome on a population from the Andes Mountains of Peru and compare it to a sea-level population. Methods: A cross-sectional study of subjects aged 30 years old or more from the high-altitude population of San Pedro de Cajas (SPC) (13,450 feet) and the sea-level population of Rimac (331 feet) was done. The metabolic syndrome was identified according to the revised National Cholesterol Education Program definition. The prevalence of metabolic abnormalities was calculated by gender, age, and population. A multivariate analysis was done with metabolic syndrome as the dependant variable. Results: Ninety-nine subjects from SPC and 172 from Rimac were included. The prevalence of metabolic syndrome was higher in SPC (22.2% versus 16.9%; p = 0.28). Prevalence of hypertriglyceridemia was significantly higher in SPC (56.6% versus 29.7%; p < 0.001) and prevalence of high blood pressure was significantly higher in Rimac (30.8% versus 18.2%; p < 0.05). In the multivariate analysis female gender was a risk factor for metabolic syndrome (odds ratio [OR] = 4.2; 95% confidence interval [CI]: 1.76-9.15). Conclusions: We found an overwhelming predominance of females with the metabolic syndrome in both populations due to high prevalences of abdominal obesity and low highdensity lipoprotein (HDL) Hypertriglyceridemia prevalence was elevated in both men and women of high altitude. Lower prevalence of high blood pressure and of high fasting glucose was found in the high-altitude natives. The prevalence and characteristics of the metabolic syndrome apparently varies among different ethnic groups and this indicates the need for more epidemiologic studies.
Abstract: BACKGROUND: Castleman's disease (CD) is a very rare disorder of unknown etiology that is characterized by masses of lymphoid tissue. METHODS: The records of all patients with a histological diagnosis of CD who were seen at the Hospital Nacional Cayetano Heredia and the Instituto Nacional de Enfermedades Neoplásicas between 1985 and 2003 and 1985 and 2001, respectively, were reviewed. RESULTS: The study included 10 patients. The age of onset ranged from 5 to 65 years. Nine patients met the criteria for localized CD; six of them were asymptomatic. The most common sites of presentation were the cervical lymph nodes (n=5), submaxilar lymph nodes (n=2), parotid gland (n=1), and lung (n=1). Eight patients had histological evidence of the hyaline-vascular variant and one had the plasma-cell variant. The primary treatment was complete surgical resection. One patient met the criteria for multicentric CD; he was asymptomatic, had histological evidence of the plasma-cell variant, and was treated with combination chemotherapy. All ten patients are currently alive with no evidence of recurrence. CONCLUSION: The localized form of CD presents as progressive, painless, slow-growing lymph node enlargement that is generally asymptomatic. The locations most commonly involved in the localized form are the cervical lymph nodes, followed by the submaxillary lymph nodes, where it poses a diagnostic challenge to the clinician because it tends to mimic other head and neck diseases. Localized CD is almost always of the hyaline-vascular variant and complete surgical excision of the tumor allows full recovery in all cases.
Abstract: Kaposi's sarcoma (KS) has been classified in four clinical variants (classic or Mediterranean; endemic or African; epidemic or AIDS-related; iatrogenic or immunosuppression-related). Human herpesvirus 8 (HHV-8), has been found in all these variants. We herein discuss the unusual presentation of a 53-year-old indigenous patient with purplish-brown nodular lesions on lower extremities, and miliary tuberculosis. ELISA-HIV tests were negative and immunohistochemistry (IHC) of the tumor tissue was positive for HHV-8. This is the first reported case in which the presence of HHV-8 was evidenced by means of IHC techniques in Peru. We also review all available Peruvian literature of classic KS, a disease that has been frequently reported in indigenous population of Peru since 1968, making this country a possible endemic zone of classic KS.
Abstract: Some studies have found different distribution patterns for the lipid profile of high altitude populations, having found the majority of them a more favorable one in these subjects. The objective of this study is to describe the lipid profile of a high altitude population and relate it to the waist circumference, body mass index, gender, and age. A descriptive study was done in an adult population, 30 yr old and above, of the town of San Pedro de Cajas (SPC), Peru, located at 4100 m (13,450 ft) above sea level. One hundred and two representative individuals (38 males and 64 females) were included. HDL cholesterol and triglyceride means were elevated, whereas total cholesterol means were average, and LDL cholesterol means were low. The BMI mean was 25.4 +/- 3.7. We observed a high prevalence of hypercholesterolemia (34.3%) and hypertriglyceridemia (53.9%) in both genders. Higher prevalences of low HDL (45.3%), abnormal waist circumference (64%), and obesity (14.1%) were found in women (p < 0.001). A higher prevalence of low HDL in overweight/obese (74.2%) and abnormal waist circumference (77.4%) subjects was evident (p < 0.001). We found high prevalences of hypercholesterolemia and hypertriglyceridemia for both genders and important prevalences of risk factors for cardiovascular disease and coronary heart disease, such as hypertriglyceridemia, low HDL, abnormal waist circumference, and obesity, in high altitude natives, especially in women.
Abstract: OBJECTIVE: To review the current South American literature on classic Kaposi's sarcoma (KS) and human herpesvirus 8 (HHV-8), and point the way for studies that still need to be performed. MATERIALS AND METHODS: The authors performed an exhaustive search in LILACS, SCIELO and PUBMED databases for classic KS and HHV-8 in South America. The relevant material was evaluated and reviewed. RESULTS: More than 250 cases have been reported with three big case series (Argentina, Colombia and Peru). The classic KS form seen in Colombia resembles the type of disease seen among African communities; the same unusual presentation with confluent exophytic nodules or eroded lesions has been noticed in Peru. Low rates of HHV-8 antibodies have been found in blood donors from Chile, Argentina and Brazil (3%, 4%, 2.8-7.4%, respectively); whereas high rates of HHV-8 antibodies have been found in Amerindians from Brazil and Ecuador. Five specimens from Argentina were subtyped: (three classic KS and two AIDS KS); the identified strains fell into subtypes A and C. AIDS-related KS specimens from Brazil and Venezuela were subtyped: (43 and nine respectively); analysis grouped them predominantly into subgroups A, B and C. A new HHV-8 subtype E was found endemic in Brazilian and Ecuadorian Amerindians. In French Guiana ten endemic KS and six AIDS-related KS specimens were subtyped; analysis grouped them predominantly into subgroups A, B and C. CONCLUSION: Classic KS in South America has a very similar clinical presentation but not the same as the classic KS variety described in the Mediterranean. Initial seroprevalence studies performed in the general population and in blood donors showed low seroprevalence of HHV-8, whereas high seroprevalence rates were seen in Amerindian population. The existing serological assays, nonetheless, need to be further refined, and new assays need to be developed. Finally, the key to understanding the precise molecular epidemiology and phylogenetic distribution of HHV-8 in South America would be to perform more subtyping of classic KS cases.
Abstract: Classic Kaposi Sarcoma (KS) may affect mucosa, especially oral cavity and any part of the gastrointestinal tract. It has been reported in 10% of patients with classic KS. We report a 35-year old male patient with primary classic KS in jejunum that presented with bowel obstruction. Primary presentation of classic KS in the gastrointestinal tract is very infrequent. There have only been 9 cases of primary KS in colon reported in literature, and none in jejunum. This is the first primary classic KS in jejunum described in our country. Likewise, we recommend that certain patients with classic KS should have an upper gastrointestinal endoscopy to determine compromise. The few gastrointestinal KS reported cases may be due to subdiagnosis.
Abstract: BACKGROUND: Classic Kaposi sarcoma (KS) occurs predominantly among the elderly, with predominance among Jews, Italians, and Greeks. Classic KS has been seen relatively frequently in Peru. OBJECTIVE: Our purpose was to outline the epidemiological and clinical profile of classic KS in Peru. METHODS: Epidemiological and clinical features of all classic KS cases diagnosed between 1969 and 2003 at Hospital Nacional Cayetano Heredia (HNCH) and between 1946 and 2004 at Instituto Nacional de Enfermedades Neoplasicas (INEN) were reviewed and studied retrospectively. RESULTS: An overall incidence of 2.54 per 10,000 attended patients was obtained at the INEN during the 48-year period (mean, 2.39; standard deviation: 1.99; 95% confidence interval, 2.92-1.86). Twenty-one cases were discovered at HNCH and 106 cases at INEN. A male/female ratio of 2.62:1 was found. Mean age at diagnosis was 68.5 years. Lower limbs were involved in 109 patients (85.8%); the trunk was involved in 11 patients (8.6%). Nodules were the most common type of lesion (85.8%); less commonly found were plaques (27.5%), macules (12.5%), papules (12.5%), and ulcers (8.6%). Sixty-two patients had no symptoms (48.8%). Pain was the most common symptom (26.7%), followed by edema (21.2%), bleeding (14.9%), and pruritus (3.9%). A second primary malignancy was found in 11 patients (8.6%). LIMITATIONS: These results were obtained from patients with classic KS in Peru and may not be applicable to other populations. CONCLUSION: Classic KS is quite common in Peru with sporadic cases found throughout the country and some clustering in the coastal region. Classic KS in Peru has a clinical presentation that is very similar, but not identical, to the classic KS described in the Mediterranean region, exhibiting some special clinical and epidemiological characteristics with a nodular, nonsymmetric presentation that usually affects the lower extremities.
