RESUMO
The influence of chronic immunosuppression on the course of chikungunya virus (CHIKV) infection in recipients of solid organ transplantation (SOT) is still unsettled. Scarce data suggest that the course of CHIKV infection is generally benign in this population. In addition, the occurrence of severe atypical manifestations associated with CHIKV has not been well documented among SOT recipients. In this report, we describe a 64-year-old male liver transplant recipient who was admitted with fever, headache, arthralgia, left palpebral ptosis, mydriasis, and right hemiparesis. Cranial magnetic resonance imaging did not reveal any alteration suggestive of acute infection. Nevertheless, CHIKV was detected in the cerebrospinal fluid (CSF) with a real-time reverse transcriptase assay. Other PCR assays carried out in CSF were negative for HSV-1 and 2, cytomegalovirus, dengue virus (DENV), and Zika virus (ZIKV). CHIKV viremia was also detected while PCR assays for ZIKV and DENV in the blood were negative. ZIKV viruria was simultaneously present in this case. All neurologic manifestations waned within 2 weeks after the onset. This report shows that chikungunya must be considered in the differential diagnosis of acute neurologic disease in SOT recipients who live in or have recently traveled to endemic areas.
Assuntos
Febre de Chikungunya , Transplante de Fígado , Dengue , Vírus da Dengue , Humanos , Masculino , Pessoa de Meia-Idade , Zika virus , Infecção por Zika virusRESUMO
Zika virus (ZIKV) transmission through non-mosquito-dependent routes has become increasingly important since reports of sexual transmission. Breastfeeding is a potential means of ZIKV transmission, but data on this remain limited. The cases of four mothers with laboratory-proven infections are reported. No disease evolved in three of the breastfed babies despite detectable maternal viremia and viruria, the presence of viral RNA shedding, and the isolation of infective particles in one milk sample. Fever and rash in one infant of a ZIKV-infected mother proved to be related to chikungunya virus infection. The results suggest that the presence of infective particles in breast milk may not be sufficient for the efficient perinatal transmission of ZIKV.
Assuntos
Transmissão Vertical de Doenças Infecciosas , Leite Humano/virologia , Eliminação de Partículas Virais , Infecção por Zika virus/transmissão , Adulto , Aleitamento Materno , Feminino , Humanos , Lactação , Gravidez , RNA Viral/análiseRESUMO
O copagamento como complemento ao financiamento de unidades públicas de saúde é uma recomendação específica do Banco Mundial para reformar sistemas de saúde e tem sido amplamente utilizado no contexto internacional. O Brasil é uma exceção. O objetivo do trabalho foi analisar a situação do copagamento no Sistema Único de Saúde diante da constatação de sua ocorrência em dois municípios de uma microrregião de Minas Gerais. A questão principal a ser respondida foi: trata-se de um caso anômalo, isolado, ou uma prática não privilegiada pelas análises da implementação da política de saúde no Brasil na atualidade, uma tendência a ser monitorada?.
Joint payment as a complement to finance public health unities is a specific recommendation by the World Bank in order to rearrange health systems, and it has been widely used throughout the world. Brazil is an exception. The aim of the article is to analyze the situation of joint payment in Sistema Único de Saúde - SUS - (Unique Health System) in two cities of a micro-region in Minas Gerais State. The main question to be answered was if we were facing an anomalous isolated case or if it was a practice non-privileged by the analyses of implementation of public health currently in Brazil, a tendency to be monitored.