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Tuberculosis (TB) is one of the leading causes of death by infectious diseases worldwide. Multidrug-resistant tuberculosis is a growing problem, especially in countries with high TB prevalence. Although the lungs are the organs most frequently affected by this disease, Mycobacterium tuberculosis can harm any organ, including the urogenital tract, causing extrapulmonary tuberculosis, which leads to a challenging diagnosis and consequent treatment delays. In this article, we present a case of orchiepididymitis caused by multidrug-resistant TB (MDR-TB) with a significantly delayed diagnosis, the proposed treatment according to the resistance profile, and the clinical outcomes.

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AIDS-related disseminated histoplasmosis (DH) can cause septic shock and multiorgan dysfunction with mortality rates of up to 80%. A 41-year-old male presented with fever, fatigue, weight loss, disseminated skin lesions, low urine output, and mental confusion. Three weeks before admission, the patient was diagnosed with HIV infection, but antiretroviral therapy (ART) was not initiated. On day 1 of admission, sepsis with multiorgan dysfunction (acute renal failure, metabolic acidosis, hepatic failure, and coagulopathy) was identified. A chest computed tomography showed unspecific findings. Yeasts suggestive of Histoplasma spp. were observed in a routine peripheral blood smear. On day 2, the patient was transferred to the ICU, where his clinical condition progressed with reduced level of consciousness, hyperferritinemia, and refractory septic shock, requiring high doses of vasopressors, corticosteroids, mechanical ventilation, and hemodialysis. Amphotericin B deoxycholate was initiated. On day 3, yeasts suggestive of Histoplasma spp. were observed in the bone marrow. On day 10, ART was initiated. On day 28, samples of peripheral blood and bone marrow cultures revealed Histoplasma spp. The patient stayed in the ICU for 32 days, completing three weeks of intravenous antifungal therapy. After progressive clinical and laboratory improvement, the patient was discharged from the hospital on oral itraconazole, trimethoprim-sulfamethoxazole, and ART. This case highlights the inclusion of DH in the differential diagnosis of patients with advanced HIV disease, septic shock and multiorgan dysfunction but without respiratory failure. In addition, it provides early in-hospital diagnosis and treatment and comprehensive management in the ICU as determining factors for a good outcome.

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ABSTRACT AIDS-related disseminated histoplasmosis (DH) can cause septic shock and multiorgan dysfunction with mortality rates of up to 80%. A 41-year-old male presented with fever, fatigue, weight loss, disseminated skin lesions, low urine output, and mental confusion. Three weeks before admission, the patient was diagnosed with HIV infection, but antiretroviral therapy (ART) was not initiated. On day 1 of admission, sepsis with multiorgan dysfunction (acute renal failure, metabolic acidosis, hepatic failure, and coagulopathy) was identified. A chest computed tomography showed unspecific findings. Yeasts suggestive of Histoplasma spp. were observed in a routine peripheral blood smear. On day 2, the patient was transferred to the ICU, where his clinical condition progressed with reduced level of consciousness, hyperferritinemia, and refractory septic shock, requiring high doses of vasopressors, corticosteroids, mechanical ventilation, and hemodialysis. Amphotericin B deoxycholate was initiated. On day 3, yeasts suggestive of Histoplasma spp. were observed in the bone marrow. On day 10, ART was initiated. On day 28, samples of peripheral blood and bone marrow cultures revealed Histoplasma spp. The patient stayed in the ICU for 32 days, completing three weeks of intravenous antifungal therapy. After progressive clinical and laboratory improvement, the patient was discharged from the hospital on oral itraconazole, trimethoprim-sulfamethoxazole, and ART. This case highlights the inclusion of DH in the differential diagnosis of patients with advanced HIV disease, septic shock and multiorgan dysfunction but without respiratory failure. In addition, it provides early in-hospital diagnosis and treatment and comprehensive management in the ICU as determining factors for a good outcome.

RESUMO

ABSTRACT Tuberculosis (TB) is one of the leading causes of death by infectious diseases worldwide. Multidrug-resistant tuberculosis is a growing problem, especially in countries with high TB prevalence. Although the lungs are the organs most frequently affected by this disease, Mycobacterium tuberculosis can harm any organ, including the urogenital tract, causing extrapulmonary tuberculosis, which leads to a challenging diagnosis and consequent treatment delays. In this article, we present a case of orchiepididymitis caused by multidrug-resistant TB (MDR-TB) with a significantly delayed diagnosis, the proposed treatment according to the resistance profile, and the clinical outcomes.

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OBJECTIVE: To evaluate the incidence and spectrum of abdominal computed tomography imaging findings in patients with paracoccidioidomycosis. MATERIALS AND METHODS: Retrospective analysis of abdominal computed tomography images of 26 patients with disseminated paracoccidioidomycosis. RESULTS: Abnormal abdominal tomographic findings were observed in 18 patients (69.2%), while no significant finding was observed in the other 8 (30.8%) patients. CONCLUSION: Computed tomography has demonstrated to play a relevant role in the screening and detection of abdominal abnormalities in patients with disseminated paracoccidioidomycosis.

OBJETIVO: Avaliar a frequência e variedade de achados de imagem por exames de tomografia computadorizada de abdome em indivíduos com paracoccidioidomicose disseminada. MATERIAIS E MÉTODOS: Estudo retrospectivo dos exames de tomografia computadorizada de abdome de 26 pacientes com paracoccidioidomicose disseminada. RESULTADOS: Foram encontradas alterações tomográficas abdominais em 18 pacientes (69,2%) dos casos analisados e 8 pacientes (30,8%) apresentaram exames normais. CONCLUSÃO: A tomografia computadorizada de abdome mostrou grande importância no rastreamento e identificação de alterações abdominais nos pacientes com paracoccidioidomicose disseminada.

RESUMO

Objective: To evaluate the incidence and spectrum of abdominal computed tomography imaging findings in patients with paracoccidioidomycosis. Materials and Methods: Retrospective analysis of abdominal computed tomography images of 26 patients with disseminated paracoccidioidomycosis. Results: Abnormal abdominal tomographic findings were observed in 18 patients (69.2%), while no significant finding was observed in the other 8 (30.8%) patients. Conclusion: Computed tomography has demonstrated to play a relevant role in the screening and detection of abdominal abnormalities in patients with disseminated paracoccidioidomycosis. .

Objetivo: Avaliar a frequência e variedade de achados de imagem por exames de tomografia computadorizada de abdome em indivíduos com paracoccidioidomicose disseminada. Materiais e Métodos: Estudo retrospectivo dos exames de tomografia computadorizada de abdome de 26 pacientes com paracoccidioidomicose disseminada. Resultados: Foram encontradas alterações tomográficas abdominais em 18 pacientes (69,2%) dos casos analisados e 8 pacientes (30,8%) apresentaram exames normais. Conclusão: A tomografia computadorizada de abdome mostrou grande importância no rastreamento e identificação de alterações abdominais nos pacientes com paracoccidioidomicose disseminada. .

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Considerando a hospitalização como um indicador de gravidade da Infecção Respiratória Aguda (IRA), objetiva-se estudar a associação de alguns fatores ambientais com a necessidade de tratamento hospitalar em crianças com diagnóstico de IRA. Foram analisados todos os prontuários de atendimento do Pronto Socorro Municipal de Cuiabá, das crianças menores de cinco anos, de ambos os sexos, agrupados por mês do atendimento. Obedecendo às características climáticas da região, dois períodos climáticos foram levados em conta: seco (maio a outubro) e chuvoso (novembro a abril). As variáveis: temperatura, umidade relativa do ar, o número de focos de calor (queimadas) foram cotejadas. A prevalência da IRA foi 49,8 por cento; a necessidade de internação alcançou 7,6 por cento, com percentual de internações maior no período seco. Conclui-se que o período seco e a umidade relativa do ar estão associados com as hospitalizações das crianças estudadas.

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Considering hospitalization as an indicator of seriousness of acute respiratory infection (ARI), this study focuses on the association between some environmental factors with the need for hospitalization of children with a diagnosis of ARI. The study analyzed all the medical records (at the Municipal Emergency Ward in Cuiabá, Mato Grosso State) of children under five years of age (both sexes), collected by month of attendance. Two weather seasons were considered: dry (May-October) and rainy (November-April). Variables included: temperature, relative humidity, and number of fires (due to extensive slashing and burning for agriculture in the region). Prevalence of ARI was 49.8%, and hospitalization was required in 7.6% of cases, with a higher percentage during the dry season. The dry season and lower relative humidity were associated with increased pediatric hospitalization rate due to ARI.

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Objetivo: estudar a influência dos períodos climáticos (seco ou chuvoso) na morbidade da Infecção Respiratória Aguda (IRA) em crianças menores de cinco anos. Métodos: estudo transversal, com coleta de dados secundários, atráves de análise dos prontuários das crianças com até cinco anos de idade e diagnóstico de IRA, atendidas no Pronto Socorro Municipal de Cuiabá (PSMC). Obedecendo as características geográficas de Cuiabá, foram considerados dois períodos climáticos: o período seco (maio a outubro) e o chuvoso (novembro a abril). Resultados: a prevalência da IRA nas crianças foi de 50% (12.850/25.803), com percentual de 55% (7.040/12.850) casos de infecção do trato respiratório superior e 45% (5.810/12.850) casos de infecção do trato respiratório inferior. A necessidade de internação foi de 8% (977/12.850) dos casos de IRA. Entre as crianças internadas, 13% (131/977) tinham infecção do trato respiratório superior e 87% (846/977) do trato respiratório inferior (p= 0,0001). Quarenta e três por cento (5.491/12.850) das crianças receberam atendimento ambulatorial durante o período climático seco e 50% (6.373/12.850) no período climático chuvoso (p=0,001). Houve necessidade de internação hospitalar em 9% (555/6.046) das crianças com IRA atendidas no período seco e em 6% (422/6.795) delas no período chuvoso (p = 0,001). Quarenta e três por cento (5.491/12.850) das crianças receberam atendimento ambulatorial durante o período climático seco e 50% (6.373/12,850) no período climático chuvoso (p=0,001). Houve necessidade de internação hospitalar em 9% (555/6,046) das crianças com IRA atendidas no período seco e em 6% (422/6,795) delas no período chuvoso (p = 0,001). Conclusões: o período climático seco parece estar associado a um aumento de IRA que necessitam de internação hospitalar.

Objective: to study the influence of the climate periods (dry or rainy) in the morbidity of Acute Respiratory Infection (ARI) in children under five years old. Methods: a cross sectional study with analysis of all medical records (Emergency Care of Cuiabá/MT, Brazil) of children younger than five years old, gathered by month of attendance. Obeying the geographic conditions of Cuiabá, it was considered two climate periods: dry period (from May to October) and the rainy (from November to April). Results: the prevalence of ARI in Children was 49% (12.850/25.803), with 55% (7.045/12,850) cases of inferior tract respiratory infection (ITRI) and 45% (5.810/12.850) cases of superior tract respiratory infection (STRI). The necessity of hospitalization was 8% (977/12.850) in the cases of ARI. Among hospitalized children, 13% (131/977) had STRI and 87% (846/977) had ITRI. Forty three percent (5.491/12.850) of children were attended as outpatient during dry period and 6% (422/6.795) during the rainy period (p =0,001). Conclusions: the dry period is interfering in the rate of serious cases of ARI, whit higher necessity of hospitalization.

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