RESUMEN
Several atypical forms of chikungunya fever (CHIK) have been described, including neurological, cardiac and renal involvement. These forms may be related to high morbidity and mortality rates. This scoping review based on the PubMed, Scopus, and WOS databases aims to identify and summarise all the available evidence regarding the clinical and histopathological presentations and risk factors associated with kidney injury related to CHIK, as well as the clinical impact. Thus, a total of 54 papers were selected from 1606 initial references after applying the defined inclusion criteria. Data on the association between kidney injury and CHIK are scarce, with studies only conducted in the acute phase of the disease, lacking further characterisation. Kidney injury incidence in hospitalised patients using the Kidney Disease Improving Global Outcomes criteria varies from 21% to 45%, being higher among patients with atypical and severe manifestations. Although acute kidney injury does not seem to be related to viraemia, it may be related to higher mortality. Few studies have described the renal histopathological changes in the acute phase of CHIK, with prevalent findings of acute interstitial nephritis with mononuclear infiltrate, glomerular congestion and nephrosclerosis. Only one study assessed the kidney function of patients in the subacute and chronic phases of CHIK. Additionally, individuals with comorbidities, including chronic kidney disease, may be among those with a greater risk of presenting worse outcomes when affected by CHIK. The results described herein may contribute to better understand the relationship between the kidneys and chikungunya virus.
Asunto(s)
Lesión Renal Aguda , Fiebre Chikungunya , Virus Chikungunya , Nefritis Intersticial , Humanos , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/epidemiología , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , RiñónRESUMEN
BACKGROUND:: Kaposi's sarcoma continues to be the most common human immunodeficiency virus - associated neoplasm with considerable morbidity and mortality. OBJECTIVE:: To describe the clinical and laboratory characteristics, initial staging, and outcomes of aids patients with Kaposi's sarcoma at an university hospital of Recife, Pernambuco. METHODS:: This is a descriptive study with analytic character, retrospective, of a case series between 2004 and 2014. RESULTS:: Of the 22 patients included in the study, 20 were aged <40 years (72.7%). The majority had CD4+ T lymphocyte counts of <200 cells/mm3 (77.3%) and human immunodeficiency virus loads of <100,000 copies/mL (78.9%). Lesions were most commonly observed on the skin (90%), and internal organs were affected in 11 of the 22 patients. Only 7 (31.8%) of the 22 patients were undergoing antiretroviral therapy (ART) at the time of Kaposis sarcoma diagnosis, and the initial disease staging classification was high risk (Aids Clinical Trials Group Oncology Committee) in 19 of the 22 patients (86.4%). Regarding Kaposi's sarcoma treatment, 17 of 22 patients (77.3%) underwent systemic chemotherapy + ART and 5 were treated exclusively with ART. Eight of the 22 patients died (36.5%); of these, 87.5% had died within one year of Kaposi's sarcoma diagnosis. LIMITATION OF THE STUDY:: Without a control group, this study cannot be used to generate hypotheses. CONCLUSIONS:: Despite the association between aids and late Kaposi's sarcoma diagnosis in the study population, including an unfavorable risk at the time of staging, a lower mortality rate was observed relative to other studies; this might be related to access to a specialized health service.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Sarcoma de Kaposi/mortalidad , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adolescente , Adulto , Terapia Antirretroviral Altamente Activa , Brasil/epidemiología , Linfocitos T CD4-Positivos , Femenino , Infecciones por VIH/complicaciones , Hospitales Universitarios , Humanos , Masculino , Mortalidad , Estudios Retrospectivos , Sarcoma de Kaposi/diagnóstico , Sarcoma de Kaposi/tratamiento farmacológicoRESUMEN
Abstract: Background: Kaposi's sarcoma continues to be the most common human immunodeficiency virus - associated neoplasm with considerable morbidity and mortality. Objective: To describe the clinical and laboratory characteristics, initial staging, and outcomes of aids patients with Kaposi's sarcoma at an university hospital of Recife, Pernambuco. Methods: This is a descriptive study with analytic character, retrospective, of a case series between 2004 and 2014. Results: Of the 22 patients included in the study, 20 were aged <40 years (72.7%). The majority had CD4+ T lymphocyte counts of <200 cells/mm3 (77.3%) and human immunodeficiency virus loads of <100,000 copies/mL (78.9%). Lesions were most commonly observed on the skin (90%), and internal organs were affected in 11 of the 22 patients. Only 7 (31.8%) of the 22 patients were undergoing antiretroviral therapy (ART) at the time of Kaposis sarcoma diagnosis, and the initial disease staging classification was high risk (Aids Clinical Trials Group Oncology Committee) in 19 of the 22 patients (86.4%). Regarding Kaposi's sarcoma treatment, 17 of 22 patients (77.3%) underwent systemic chemotherapy + ART and 5 were treated exclusively with ART. Eight of the 22 patients died (36.5%); of these, 87.5% had died within one year of Kaposi's sarcoma diagnosis. Limitation of the study: Without a control group, this study cannot be used to generate hypotheses. Conclusions: Despite the association between aids and late Kaposi's sarcoma diagnosis in the study population, including an unfavorable risk at the time of staging, a lower mortality rate was observed relative to other studies; this might be related to access to a specialized health service.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Sarcoma de Kaposi/mortalidad , Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Sarcoma de Kaposi/diagnóstico , Sarcoma de Kaposi/tratamiento farmacológico , Brasil/epidemiología , Linfocitos T CD4-Positivos , Infecciones por VIH/complicaciones , Estudios Retrospectivos , Mortalidad , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Terapia Antirretroviral Altamente Activa , Hospitales UniversitariosRESUMEN
INTRODUCTION: Significant reactions frequently occur among leprosy cases, and thus a significant proportion of leprosy patients present disabilities and undergo leprosy retreatment. Clinical-epidemiological characterization of reaction patterns is essential for managing such patients. Objective to describe the epidemiological and clinical characteristics of leprosy reactions among paucibacillary and multibacillary individuals. METHODS: In this cross-sectional study, 201 patients with histories of reactions who were attended at two reference centers for leprosy treatment were evaluated. Variables such as initial bacilloscopy, sex, age, skin phototype, origin, clinical presentation, type of treatment, type of reaction, final bacilloscopy index and time of reaction onset in relation to the treatment were evaluated. Statistical analysis was performed using simple frequencies. To calculate risk factors for multibacillary forms, univariate and multivariate analyses were performed. RESULTS: Male sex, age between 30 and 44 years, phototype V, borderline clinical form, regular treatment, type I reaction, neuritis, presence of 10 to 20 nodules and onset of the leprosy reaction during the treatment were the most frequent findings. CONCLUSIONS: Male patients predominated and were associated with greater risk of developing the multibacillary forms. Leprosy reactions occurred most frequently during the treatment. Multibacillary patients were more likely to need leprosy retreatment, and those with type I and type II reactions presented greater frequency of neuritis, lymphadenopathy, arthritis and iritis than did those with isolated reactions.
Asunto(s)
Lepra Multibacilar/diagnóstico , Lepra Paucibacilar/diagnóstico , Adolescente , Adulto , Análisis de Varianza , Brasil , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Leprostáticos/uso terapéutico , Lepra Multibacilar/tratamiento farmacológico , Lepra Multibacilar/patología , Lepra Paucibacilar/tratamiento farmacológico , Lepra Paucibacilar/patología , Masculino , Persona de Mediana Edad , Recurrencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Adulto JovenRESUMEN
INTRODUÇÃO: As reações são frequentes e importantes no contexto da hanseníase, representando uma significativa parcela de pacientes com incapacidades e submetidos ao retratamento da hanseníase. A caracterização clínico-epidemiológica dos padrões reacionais é primordial para o manejo dos pacientes. O objetivo desse trabalho é descrever as características epidemiológicas e clínicas das reações hansênicas em indivíduos paucibacilares e multibacilares. MÉTODOS: Estudo transversal onde foram avaliados 201 pacientes com história de quadro reacional, atendidos em dois centros de referência para tratamento da hanseníase. Variáveis como baciloscopia inicial, sexo, idade, fototipo, procedência, forma clínica, tipo de tratamento e de reação, índice baciloscópico final e período de surgimento da reação em relação ao tratamento foram avaliados. A análise estatística foi realizada usando-se frequências simples. Para cálculo dos fatores de risco para as formas multibacilares, foram realizadas análises univariada e multivariada. RESULTADOS: Sexo masculino, idade entre 30-44 anos, fototipo V, a forma clínica borderline, tratamento regular, reação tipo I, neurite, presença de 10 a 20 nódulos e surgimento da reação hansênica durante o tratamento foram os achados mais frequentes. CONCLUSÕES: Predominaram os indivíduos do sexo masculino que se associaram a um maior risco de desenvolvimento da forma multibacilar. As reações hansênicas foram mais frequentes durante o tratamento, os pacientes multibacilares foram mais propensos ao retratamento da hanseníase e aqueles com reações tipo I e II, apresentaram maior frequência de neurite, linfadenopatia, artrite e irite do que aqueles com reação isolada.
INTRODUCTION: Significant reactions frequently occur among leprosy cases, and thus a significant proportion of leprosy patients present disabilities and undergo leprosy retreatment. Clinical-epidemiological characterization of reaction patterns is essential for managing such patients. Objective to describe the epidemiological and clinical characteristics of leprosy reactions among paucibacillary and multibacillary individuals. METHODS: In this cross-sectional study, 201 patients with histories of reactions who were attended at two reference centers for leprosy treatment were evaluated. Variables such as initial bacilloscopy, sex, age, skin phototype, origin, clinical presentation, type of treatment, type of reaction, final bacilloscopy index and time of reaction onset in relation to the treatment were evaluated. Statistical analysis was performed using simple frequencies. To calculate risk factors for multibacillary forms, univariate and multivariate analyses were performed. RESULTS: Male sex, age between 30 and 44 years, phototype V, borderline clinical form, regular treatment, type I reaction, neuritis, presence of 10 to 20 nodules and onset of the leprosy reaction during the treatment were the most frequent findings. CONCLUSIONS: Male patients predominated and were associated with greater risk of developing the multibacillary forms. Leprosy reactions occurred most frequently during the treatment. Multibacillary patients were more likely to need leprosy retreatment, and those with type I and type II reactions presented greater frequency of neuritis, lymphadenopathy, arthritis and iritis than did those with isolated reactions.
Asunto(s)
Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Adulto Joven , Lepra Multibacilar/diagnóstico , Lepra Paucibacilar/diagnóstico , Análisis de Varianza , Brasil , Estudios Transversales , Leprostáticos/uso terapéutico , Lepra Multibacilar/tratamiento farmacológico , Lepra Multibacilar/patología , Lepra Paucibacilar/tratamiento farmacológico , Lepra Paucibacilar/patología , Recurrencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Adulto JovenRESUMEN
Introdução: a literatura tem divergido em relação ao acometimento de cabeça e pescoço em crianças mais velhas e adultos imunocompetentes com escabiose clássica, alguns artigos referindo que estas localizações não são acometidas e outros evidenciando prevalência de até 10%. Como o tratamento tópico destas duas regiões não é unanimamente recomendado neste grupo etário, poder-se-ia esperar que a persistência de lesões não tratadas levasse a maior chance de complicações e disseminação da parasitose. Objetivos: estudar a prevalência de escabiose em cabeça e pescoço entre os infestados com cinco ou mais anos de idade. Métodos: foram examinados 124 pacientes com cinco ou mais anos de idade com escabiose clássica que procuraram o Ambulatório de Dermatologia, sendo realizado exame meticuloso da cabeça e pescoço. Resultados: foram observadas lesões em cabeça e pescoço em 35,8% dos pacientes, estando presentes no couro cabeludo em 8,1%, na face em 4,9%, na região auricular, retroauricular e pré-auricular em 12,2% e no pescoço em 26,8%. Conclusão: a escabiose acometeu a cabeça e pescoço de infestados com cinco ou mais anos de idade que procuraram o Ambulatório de Dermatologia em proporção maior que a descrita na literatura. Os dados encontrados alertam o profissional de saúde a não negligenciar o exame da cabeça e pescoço dos pacientes com escabiose.
RESUMEN
Apesar de o acometimento de cabeça e pescoço de crianças mais velhas e adultos na escabiose ser conhecido, a literatura é pobre em sua descrição. Estudados 124 pacientes com escabiose clássica com cinco anos de idade ou mais, para pesquisa, descrição e registro fotográfico das lesões de cabeça e pescoço. Esses locais foram acometidos em 35,8 por cento dos casos, e as lesões mais encontradas foram crostas hemáticas, pápulas eritematosas com e sem escoriações ou crostas sobrepostas e descamação adjacente.
Although the head and neck are known to be affected by scabies in older children and adults, the literature is quite scarce on this topic. A study with 124 patients aged 5 years or older with classic scabies was carried out to investigate, describe and photographically register lesions on head and neck. These sites were affected in 35.8 percent of cases, and the lesions more often observed were crusts, erythematous papules with or without excoriations and crusts, and scaling around lesions.