RESUMO
The burden of histoplasmosis has been poorly documented in most of the endemic areas for the disease, including Brazil. Also, modern non-culture-based diagnostic tests are often non-available in these regions. This was a prospective cohort study in HIV-infected patients with suspected disseminated disease evaluated with different diagnostic tests. Patients were enrolled in three referral medical centres in Porto Alegre, Brazil. Among 78 evaluated patients, disseminated histoplasmosis was confirmed in eight individuals (10.3%) by the means of classical (culture/histopathology) tests. Antigen detection in the urine was found to be more sensitive: IMMY® ALPHA ELISA detected 13 positive cases (16.7%) and the in-house ELISA test developed by the Centers for Disease Prevention and Control (CDC) detected 14 (17.9%). IMMY® and CDC tests provided concordant results in 96.2% of cases. This is the first study to compare the performance of the in-house CDC ELISA test with the IMMY® commercial test for the diagnosis of histoplasmosis, and a high degree of concordance was observed. The study revealed that H. capsulatum is an important agent of disseminated disease in AIDS patients in Brazil, reinforcing the importance of making available modern diagnostic tests as well as safer antifungal agents for the treatment of histoplasmosis.
Assuntos
Síndrome da Imunodeficiência Adquirida/diagnóstico , Testes Diagnósticos de Rotina/métodos , Histoplasmose/sangue , Histoplasmose/diagnóstico , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/imunologia , Adulto , Antígenos de Fungos/urina , Brasil/epidemiologia , Estudos de Coortes , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Infecções por HIV/sangue , Infecções por HIV/epidemiologia , Infecções por HIV/microbiologia , Infecções por HIV/virologia , Histoplasma/imunologia , Histoplasmose/epidemiologia , Histoplasmose/imunologia , Humanos , Imunoensaio/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Centros de Atenção TerciáriaRESUMO
Previous studies have demonstrated reduced virulence in the species that comprise the Candida parapsilosis complex. We investigated a cohort of 93 patients with candidemia caused by this complex. Most infections were caused by C. parapsilosis (80.6%), followed by C. orthopsilosis (18.3%) and C. metapsilosis (1.1%). Renal failure (P < 0.001) and chronic liver diseases (P = 0.019) were more frequently encountered with infections caused by the C. orthopsilosis group, suggesting an association with patients who had a greater state of immune suppression in comparison with infections caused by C. parapsilosis sensu stricto.
Assuntos
Candida/classificação , Candida/isolamento & purificação , Candidemia/epidemiologia , Candidemia/microbiologia , Candidemia/complicações , Estudos de Coortes , Humanos , Hepatopatias/epidemiologia , Hepatopatias/etiologia , Prevalência , Insuficiência Renal/epidemiologia , Insuficiência Renal/etiologia , Medição de Risco , Fatores de RiscoRESUMO
Cutaneous injuries of the inferior third of the leg and dorsum of the foot represent a great challenge for plastic surgeons. The poor vascularization and subsequent poor healing encountered in these regions demand detailed knowledge of the local anatomy to select the best surgical alternative for each patient. In patients in whom local or free muscular flaps are not suitable, the fasciocutaneous flaps seem to be a good alternative. The distal pedicled fasciocutaneous flap of the calf was used to cover skin defects of the leg and foot in 22 patients. In 4 patients the authors designed an island flap to prevent a large defect in the donor area and to decrease the time of hospitalization and recovery of the patient. In a severe defect, the flap was used as a cross-leg flap. The results were satisfactory because the flap provided stable coverage for different defects with few complications. The island flap is a good option for achieving a better aesthetic result and can be used in select patients.
Assuntos
Traumatismos do Pé/cirurgia , Traumatismos da Perna/cirurgia , Retalhos Cirúrgicos , Humanos , Retalhos Cirúrgicos/irrigação sanguíneaRESUMO
The authors present an anatomical study of a fasciocutaneous flap of the lower limb and its clinical application. Sixteen patients with loss of cutaneous substance and exposure of the leg bone were operated on. The bipedicled fasciocutaneous flap presented by the authors allows the coverage of large areas of the lower limb in the initial stage of treatment. Preservation of the superficial venous system allows for a better vascularization of the flap and, thus, for the use of larger flaps.