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Differently from immunocompromised patients, very little information is available in the literature regarding the clinical presentation, epidemiology, and outcomes of histoplasmosis in non-immunosuppressed individuals living in endemic areas. This retrospective case series study was carried out by reviewing the medical records of non-immunocompromised patients with histoplasmosis, residents in a hyperendemic area in northeastern Brazil, between 2011 and 2022. Thirty HIV-negative patients were identified with histoplasmosis, and 19 cases met the inclusion criteria: three had acute, five subacute and one chronic pulmonary forms; two with mediastinal picture and eight had disseminated disease (two with severe symptoms). The median age of our sample was 32.7 years old [interquartile range: 24-45]. Most of the patients were male (male-to-female ratio = 15:4) and resided in the state capital (n = 9). The majority had a previous history of exposure to well-known risk factors for Histoplasma infection. Pulmonary nodules were observed in all subacute form, two patients (acute and subacute forms) were initially treated empirically for pulmonary tuberculosis; one death was registered in the subacute form. The chronic pulmonary form of histoplasmosis was diagnosed in one patient only after the symptoms persisted despite specific treatment. The primary clinical manifestations of the moderate form of DH were enlarged lymph nodes, with histopathology being the main diagnostic method. The cases were detected as isolated occurrences and not as an outbreak, suggesting that exposure to Histoplasma can be more widespread than presumed. Despite the self-limiting nature of the disease, death can occur even in previously heathy patients.
This study aimed to describe the presentation of histoplasmosis outside the context of immunosuppression, including the diagnostic methods, epidemiology, and main radiological and clinical features. A better understanding of the various forms of this disease will help improve case management.
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Doenças Endêmicas , Histoplasma , Histoplasmose , Humanos , Histoplasmose/epidemiologia , Brasil/epidemiologia , Masculino , Feminino , Adulto , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto Jovem , Histoplasma/isolamento & purificação , Fatores de RiscoRESUMO
(1) Background: Only a few studies on histoplasmosis in immunocompetent patients have been reported in French Guiana. Therefore, we conducted a detailed clinical description of hospitalized patients suffering with histoplasmosis among non-HIV patients. (2) Methods: This is a single-center, retrospective study conducted at Cayenne Hospital Center between 2008 and 2022. (3) Results: Our cohort was composed of 31 (91%) adults (>18 years of age) and 3 (9%) children, with a sex ratio, M:F, of 1:2. The median age was higher among the women than among the men (70 versus 54 years). The collection of respiratory samples constituted the majority of the performed examinations (38%). Fever (>37 °C) was found in 56% of patients. Surprisingly, the histoplasmosis was disseminated in 82% of patients with an overall case fatality rate of 14.7%. However, immunosuppressive conditions were found in 52% (16/31) of the adult patients, including lymphoid hemopathies, diabetes and immunosuppressive drugs. Conclusions: This disease, though rare and usually considered a mostly benign disease in non-HIV patients, presented a relatively high mortality rate in our cohort. Thus, histoplasmosis should be suspected, screened and investigated as a first line of defense in highly endemic areas, even in immunocompetent and non-HIV patients, especially those with fever or chronic respiratory symptoms.
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Histoplasmosis is an endemic and invasive mycosis caused by Histoplasma capsulatum. We conducted a retrospective study comparing immunosuppressed patients without human immunodeficiency virus (HIV) with a historical cohort of people with HIV and histoplasmosis. We included 199 patients with proven or probable histoplasmosis, of which 25.1% were people without HIV. Diabetes mellitus, chronic kidney disease, hematologic neoplasms, rheumatologic diseases, and transplantations were more frequent among people without HIV (P < .01). Forty-four percent of immunocompromised patients without HIV died within the first 6-week period following their diagnosis. A high suspicion index for histoplasmosis should be kept in immunosuppressed patients.
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ABSTRACT Despite being subject to lower AIDS-related mortality rates and having a higher life expectancy, patients with HIV are more prone to develop non-AIDS events. A low CD4+/CD8+ ratio during antiretroviral therapy identifies people with heightened immune senescence and increased risk of mortality. In clinical practice, finding determinants of a low CD4+/CD8+ ratio may be useful for identifying patients who require close monitoring due to an increased risk of comorbidities and death. We performed a prospective study on the evolution of the CD4+/CD8+ ratio in 60 patients infected with HIV (80% males), who were subjected to two different antiretroviral regimens: early and deferred therapy. The initial CD4+/CD8+ ratio was ≤1 for 70% of the patients in both groups. Older age, CD4+ cell count at inclusion, Nadir CD8+T-cell count, and Initial CD4+/CD8+ ratio ≤ 1 were risk factors for lack of ratio recovery. In the multivariate analysis, a CD4+/CD8+ ratio > 1 at the start of the treatment was found to be a determinant factor in maintaining a CD4+/CD8+ ratio > 1. The nadir CD4+T-cell count was lower in the deferred therapy group (p=0.004), and the last CD4+/CD8+ ratio ≤1 was not associated with comorbidities. Ratio recovery was not associated with the duration of HIV infection, time without therapy, or absence of AIDS incidence. A greater improvement was observed in patients treated early (p=0.003). In contrast, the slope of increase was slower in patients who deferred treatment. In conclusion, the increase in the CD4+/CD8+ ratio occurred mostly for patients undergoing early strategy treatment and its extension did not seem to be related to previous HIV-related factors.
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Cryptococcosis is traditionally associated with immunocompromised patients but is increasingly being identified in those without the human immunodeficiency virus (HIV) or other immunocompetent individuals. We aim to describe the characteristics, mortality, and associated variables with death among hospitalized patients with cryptococcosis in Brazil. This is the first multicenter retrospective cohort study conducted in seven public tertiary Brazilian hospitals. A total of 384 patients were included; the median age was 39 years and 283 (73.7%) were men. In all, 304 HIV-positive were hosts (79.2%), 16 (4.2%) solid organ transplant (SOT), and 64 (16.7%) non-HIV-positive/non-transplant (NHNT). Central nervous system (CNS) cryptococcosis had a significantly higher number across disease categories, with 313 cases (81.5%). A total of 271 (70.6%) patients were discharged and 113 (29.4%) died during hospitalization. In-hospital mortality among HIV-positive, SOT, and NHNT was 30.3% (92/304), 12.5% (2/16), and 29.7% (19/64), respectively. Induction therapy with conventional amphotericin B (AMB) mainly in combination with fluconazole (234; 84.2%) was the most used. Only 80 (22.3%) patients received an AMB lipid formulation: liposomal (n = 35) and lipid complex (n = 45). Most patients who died belong to the CNS cryptococcosis category (83/113; 73.4%) when compared with the others (P = .017). Multivariate analysis showed that age and disseminated cryptococcosis had a higher risk of death (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.05; P = .008 and OR, 1.84; 95% CI, 1.01-3.53; P = .048, respectively). Understanding the epidemiology of cryptococcosis in our settings will help to recognize the burden and causes of mortality and identify strategies to improve this scenario.
This multicenter cohort study included 384 hospitalized individuals with cryptococcosis in Brazil. Most individuals were men (74%), HIV-positive (79%), had central nervous system involvement (82%), and received conventional amphotericin plus fluconazole (84%). In-hospital mortality was high (29%).
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Criptococose , Transplante de Órgãos , Masculino , Animais , Humanos , Feminino , Brasil/epidemiologia , Estudos Retrospectivos , Criptococose/tratamento farmacológico , Criptococose/epidemiologia , Criptococose/complicações , Criptococose/veterinária , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/veterinária , Anfotericina B/uso terapêutico , Lipídeos/uso terapêutico , Antifúngicos/uso terapêuticoRESUMO
Mycobacterium tuberculosis, which is responsible for tuberculosis (TB) and Cryptococcus sp. responsible for cryptococcosis, are pathogenic microorganisms that especially affect patients infected with the human immunodeficiency virus (HIV). Both diseases present similar classic symptoms, which makes diagnosis and treatment consequently difficult. To our knowledge, a few reported cases of M. tuberculosis and Cryptococcus sp. co-infection in non-HIV patients exist. This study reports a TB and neurocryptococcosis (NC) comorbidity case in a patient who had no clinical or serological evidence of HIV-compromised immunity. A 49-year-old male patient, a farmer with a low education level, previously diagnosed with TB and was undergoing treatment for a month when he presented progressive headaches, fever, drowsiness and photosensitivity, a stiff neck and a positive Lasègue test. During hospitalization, the patient was also diagnosed with NC through cerebrospinal fluid (CSF) analysis, which revealed the presence of capsulated yeasts by contrast with india ink. Following the yeast isolation, proteomic and molecular analyzes were performed. The patient received antifungal therapy in parallel with TB treatment, which caused complications and had to be modified twice. However, after three months of hospitalization the patient was discharged. Tuberculosis and cryptococcosis co-infection is a clinical and laboratory challenge, often leading to a delay in diagnosis. In this paper we emphasize the need to understand these infectious comorbidities in non-HIV patients from South America, since the few cases reported in the literature are from studies conducted in the United States and China.
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Criptococose , Cryptococcus neoformans , Infecções por HIV , Tuberculose , Comorbidade , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Criptococose/epidemiologia , Cryptococcus neoformans/genética , Infecções por HIV/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Proteômica , Tuberculose/complicaçõesRESUMO
Cryptococcosis is a fungal infection that is rarely reported in patients without human immunodeficiency virus (HIV) infection, especially when the central nervous system (CNS) or pulmonary system is not involved. We report a case of isolated colonic cryptococcosis without disseminated disease in a 64-year-old immunocompetent woman without HIV infection who presented with chronic diarrhea and no episodes of fever or weight loss. The diagnosis was based on histopathology examination. Furthermore, we performed a literature review showing that few reports have been published so far and in the case of colonic cryptococcal infection, the prognosis is favorable among HIV-uninfected patients.
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Antifúngicos/administração & dosagem , Colo/microbiologia , Criptococose/microbiologia , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Criptococose/imunologia , Cryptococcus neoformans/efeitos dos fármacos , Cryptococcus neoformans/genética , Cryptococcus neoformans/isolamento & purificação , Cryptococcus neoformans/fisiologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Resumen La neumonía en el paciente inmunocomprometido es un reto diagnóstico al cual el clínico se enfrenta cada vez con más frecuencia , al momento de hablar de infiltrados en vidrio esmerilado es menester tener siempre en cuenta la posibilidad de neumonía por Pneumocystis Jirovecii, que por mucho tiempo se pensó como una enfermedad propia del huésped inmunosuprimido con VIH, a través del tiempo se ha manifestado en pacientes con trasplantes de órgano sólido y de precursores hematopoyéticos, asociado a autoinmunidad, al uso crónico de corticoesteroides y más recientemente al uso de terapia biológicas. La descripción de esta enfermedad y sus métodos diagnósticos en huéspedes inmunosuprimidos no VIH no es del todo claro, sabemos que el tratamiento de elección en estos casos es el trimetropin-sulfametoxazol (TMP-SMX) el cual no cuenta con evidencia de alta calidad al momento de plantear una dosis ni un tiempo de duración establecidos. Presentamos el caso de un paciente con diagnóstico de glomerulonefritis por enfermedad de cambios mínimos corticodependiente y quien desarrolló neumonía por Pneumocystis Jirovecii confirmada por histopatología quien recibió tratamiento y tuvo un desenlace positivo.
Abstract The pneumonia in the immunocompromised patient is a diagnostic challenge that the clinician faces more and more frequently, every time we talk about ground glass infiltrates it is necessary to always take into account the possibility of pneumonia due to Neumocystis Jirovecii, which for a long time was thought as a disease of the immunosuppressed host with HIV, but that across the time it has manifested itself in patients with solid organ transplants and hematopoietic precursors, associated with autoimmunity, the chronic use of corticosteroids and more recently the use of biological therapy. The description of this disease and the diagnostic methods in non-HIV immunosuppressed hosts is not entirely clear, we know that the treatment of choice in these cases is trimethropin-sulfamethoxazole (TMP-SMX), which does not have high-quality evidence at the time of a dose or a time of established duration. We present the case of a patient diagnosed with glomerulonephritis due to corticodependent minimal change disease and who suffers from pneumocystis Jirovecii pneumonia confirmed by histopathology, which received treatment and had a positive outcome
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Humanos , Masculino , Adolescente , Pneumonia por Pneumocystis , Pneumonia , Autoimunidade , HIV , Hospedeiro Imunocomprometido , Corticosteroides , VidroRESUMO
BACKGROUND: Coccidioidal meningitis is a life-threatening condition and a diagnostic challenge in cases of chronic meningitis. It is associated to severe complications, like basal arachnoiditis, hydrocephalus, and secondary vasculitis. OBJECTIVE: To present a 20-year retrospective clinical series of coccidioidal meningitis cases at a Mexican neurological referral center. RESULTS: The clinical records of 11 patients, predominantly males, were retrieved. Weight loss and night sweats were observed in 64 % of cases. Neurological signs included intracranial hypertension in 91 % of cases, altered alertness and meningeal syndrome in 72 %, and neuropsychiatric symptoms in 64 %. Mean CSF glucose levels were 30 ± 25 mg/dL, and pleocytosis ranged from 0 to 2218 cells/mm3. The diagnosis was confirmed by coccidioidal antigen latex agglutination in 91 % of cases. Radiological findings were hepatomegaly in 55 % of cases and pneumonia in 45 %. Neuroimaging findings included leptomeningitis in 73 % of cases, pachymeningitis in 45 %, and vascular involvement in 91 %. Less common findings included spinal cord lesion and mycotic aneurism, found in 18 % of cases. A molecular coccidioidal DNA test confirmed the predominance of Coccidioides immitis, detected in 64 % of cases. With respect to the clinical outcome, 46 % of patients died. The survivors suffered from sequels like chronic headache, cognitive alterations, and depression. CONCLUSIONS: Coccidioidal meningitis is an entity with high mortality rates. More than one half of patients suffered disseminated disease. Although meningeal signs are not frequent in chronic meningitis, more than two-thirds of our patients showed mild nuchal rigidity. In addition, cerebral and cerebellar volume loss, associated with cognitive impairment and depression, was often observed in surviving patients during the clinical-radiological follow-up.
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Antifúngicos/uso terapêutico , Encéfalo/diagnóstico por imagem , Coccidioidomicose/tratamento farmacológico , Hipertensão/etiologia , Meningite Fúngica/tratamento farmacológico , Adulto , Coccidioides/isolamento & purificação , Coccidioidomicose/complicações , Coccidioidomicose/diagnóstico por imagem , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Masculino , Meningite Fúngica/complicações , Meningite Fúngica/diagnóstico por imagem , México , Pessoa de Meia-Idade , Neuroimagem , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Due to the increasing use of immunosuppressant therapy, Pneumocystis jirovecii pneumonia (PJP) has become an emerging concern in human immunodeficiency virus (HIV)-negative patients. In this study, we conducted a retrospective study of 96 hospitalized patients with PJP from January 2015 to June 2019 at three tertiary comprehensive hospitals in Southern China. Information was collected regarding patient demographics, clinical manifestations, risk factors, laboratory analyses, radiological images, and treatment outcomes. PJP infection was most commonly found in middle-aged men. Kidney diseases (35.5%) and connective tissue diseases (38.7%) were the predominant risk factors for PJP. About half of the patients (48.4%) received glucocorticoid, immunosuppressant, and/or chemotherapy in a low dose or in a short-term (< 3 months). None of the patients had previously received trimethoprim-sulfamethoxazole (TMP-SMX) for PJP prophylaxis. All patients had two or more clinical manifestations (cough, dyspnea, fever, and chest pain). Biochemical investigations of CRP, ESR, PaO2, LDH, and KL-6 showed that over 90% of the patients exceeded the reference range of indicators. Our analyses revealed the dominant risk factors (HIV, kidney diseases, and connective tissue diseases) and the most consistent biochemical indicators (LDH, BG, and KL-6) for PJP. Moreover, early prophylaxis, diagnosis, and treatment should contribute to improve the survival of these PJP patients.
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Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/microbiologia , Adulto , Idoso , Antifúngicos/administração & dosagem , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumocystis carinii/efeitos dos fármacos , Pneumocystis carinii/fisiologia , Pneumonia por Pneumocystis/diagnóstico por imagem , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia por Pneumocystis/epidemiologia , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Combinação Trimetoprima e SulfametoxazolRESUMO
Resumen: Objetivo: Describir las características de la población de personas de 18 años o más con tuberculosis (TB) no coinfectadas con Virus de la Inmunodeficiencia Humana (VIH) en Uruguay en el período del 1 de enero de 2016 al 31 de diciembre de 2017. Métodos: Se obtuvieron los datos de la base de datos anonimizada del registro nacional de TB perteneciente a la Comisión Honoraria de Lucha Antituberculosa y Enfermedades Prevalentes (CHLA-EP) para todos los casos de TB bacteriológicamente confirmada en el período del 1/1/16 al 31/12/17. Se excluyó a todos los individuos menores de 18 años y a todos aquellos con diagnóstico positivo para el VIH. Se clasificó a dichos individuos según el sector del sistema de salud de pertenencia. Se analizó la frecuencia y proporción de variables reconocidas como vinculadas a la enfermedad para cada subgrupo. Resultados: Se registraron 1129 casos. La tasa de incidencia de TB para la población de 18 años o más no infectada por el VIH fue de de 21,8 casos cada 100.000 habitantes para el año 2016. Se observó una proporción de factores de riesgo relacionados al medio socioeconómico de 43,8% del total de la población; estos predominaron en el sector público con un 57,4%. La pérdida de seguimiento para el sector público fue de 12,8%, mientras que en el sector privado fue de 3,0%. Se vió un porcentaje de fallecimiento de 38,8% entre los desocupados. Conclusiones: Los factores de riesgo socioeconómicos predominaron en el sector público de salud. Dentro de estos, la desocupación fue la de mayor proporción y se asoció con mayor porcentaje de fallecimiento y pérdida de seguimiento como resultado de tratamiento con respecto a la población general. La mayoría de los casos presentaron la forma pulmonar, y dentro de la extrapulmonar la más frecuente fue la pleural.
Abstract. Objective: To describe the characteristics of the population with tuberculosis (TB), over the age of 18, without HIV infection in Uruguay in the period between January 1st, 2016 and December 31st, 2017. Methods: Data of TB cases confirmed by sputum culture between 1/1/16 and 12/31/17 was obtained from the anonymized data base of the national register of TB, which belongs to CHLA-EP. Individuals younger than 18 or with HIV infection were excluded. Patients included in this study were organized in two groups according to the following criteria: belonging to public health care and belonging to private health care. Frequency and proportion of different variables related to TB were analyzed in those groups. Results: 1129 cases were analyzed. The incidence rate of TB amongst the population of non-HIV uruguayans over the age of 18 was 21.8 per 100,000 in 2016. Risk factors related to socioeconomic status were observed in a proportion of 43.8% of the total population; these were more prevalent within the subpopulation that received public health care, with a proportion of 57.4%. Loss of follow-up for the public health care sector was seen in 12.8% of cases, while the private sector presented 3.0%. The percentage of death among the unemployed was of 38.8%. Conclusion: Socioeconomic risk factors were predominantly superior among patients belonging to public health services. Moreover, unemployment was the most frequent factor within that category, and those who presented this factor had higher percentage of death and loss of follow up as the final outcome of treatment, compared to the general population. Pulmonary tuberculosis was the most frequent clinical form, followed by tuberculosis pleurisy as the main form of extra pulmonary tuberculosis.
Resumo: Objetivo: Descrever as características da população de 18 anos ou mais de idade com tuberculose (TB) não co-infectada pelo Vírus da Imunodeficiência Humana (HIV) no Uruguai no período de 1 de janeiro de 2016 a 31 de dezembro de 2017. Métodos: Os dados foram obtidos do banco de dados anonimizado do registro nacional de TB pertencente à Comissão Honorária de Tuberculose e Doenças Prevalentes (CHLA-EP) para todos os casos de TB bacteriologicamente confirmada no período de 1/1/16 a 31/12/17. Todos os indivíduos com menos de 18 anos e todos com diagnóstico positivo de HIV foram excluídos. Esses indivíduos foram classificados de acordo com o setor do sistema de saúde dos membros. A frequência e proporção de variáveis reconhecidas como ligadas à doença para cada subgrupo foram analisadas. Resultados: 1129 casos foram registrados. A taxa de incidência de TB na população de 18 anos ou mais de idade não infectada pelo HIV foi de 21,8 casos por 100.000 habitantes até 2016. Foi observada uma proporção de fatores de risco relacionados ao ambiente socioeconômico de 43,8. % da população total; estes predominaram no setor público com 57,4%. A perda de acompanhamento para o setor público foi de 12,8%, enquanto no setor privado foi de 3,0%. Uma taxa de mortalidade de 38,8% foi observada entre os desempregados. Conclusões: Os fatores de risco socioeconômico predominaram no setor de saúde pública. Entre eles, o desemprego foi a maior proporção e foi associado a um maior percentual de óbitos e perda de seguimento como resultado do tratamento em relação à população em geral. A maioria dos casos apresentava a forma pulmonar e, na extrapulmonar, a mais frequente era a pleural.
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Introduction: Talaromyces marneffei infection is a systemic mycosis, caused by a dimorphic fungus, an opportunistic pathogen formerly known as Penicillium marneffei. This disease is endemic to Southeast Asia and common in human immunodeficiency virus (HIV) infected patients with low CD4 counts. Here we present a very rarely reported case of Talaromyces marneffei infection in an apparent non-immunosuppressed patient presenting decades later in a non-endemic setting (United States). Presentation of case: Our patient was a 75-year-old Caucasian Navy veteran, who served in Vietnam as a part of the Swift Boat service in 1966. He presented to his primary care provider with uncontrolled nonproductive cough and abnormal chest computerized tomography. Bronchoscopy specimens showed Talaromyces. He was empirically treated with itraconazole and then switched to voriconazole after confirmation of diagnosis but he later deteriorated was changed to liposomal amphotericin B and isavuconazole. Patient did well for the next 90â¯days on isavuconazole until the therapy was stopped. Soon after stopping the medication (isavuconazole) his symptoms recurred and ultimately patient expired. Discussion: Talaromycosis generally presents as pulmonary infection with manifestations similar with other endemic fungi. It is often seen HIV patients with travel to South east Asia. Very rarely this infection is seen and reported in non-immunosuppressed and in non-endemic areas. To date there are 4 well-documented cases among non-HIV, non-endemic population. Conclusion: Talaromyces can cause infection in non-HIV and non-endemic population and could be an underrecognized cause of pulmonary infections among veterans with even a remote history of exposure to the organism during deployment.
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Cryptococcosis is a classical systemic opportunistic mycosis, primarily occurring among patients with significant immunologic impairment. However, this disease could also affect patients without any recognized immunologic defects, that is, phenotypically normal patients. The medical records of 29 non-HIV/nontransplant patients with cryptococcal disease during the period 20072014 were retrospectively reviewed. The most common site of infection was the central nervous system (n = 25, 86.2%), followed by the pulmonary system (n = 11, 37.9%) and blood (n = 2, 6.8%). Thoracic- and brain-computed tomography demonstrated abnormalities of 81.2% (n = 13) and 62.5% (n = 15), respectively. In sum, 22% (n = 6) of the patients experienced a significant underlying condition. More than one therapeutic regimen was used in 77.8% (n = 21) of the patients. The isolates were identified as being Cryptococcus neoformans species complex (n = 4, 36.4%) and Cryptococcus gattii species complex (n = 7, 63.6%). The overall mortality was 20.7% (n = 6). Herein, we presented the first case series of cryptococcosis in this specific population in SaËo Paulo City, Brazil. The incidence of cryptococcosis in our hospital has not increased in recent years, and 77.8% (n = 21) of cases had no obvious predisposing factor. However, this disease remains associated with high mortality
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Humanos , HIV , Criptococose/diagnósticoRESUMO
Cryptococcosis is a classical systemic opportunistic mycosis, primarily occurring among patients with significant immunologic impairment. However, this disease could also affect patients without any recognized immunologic defects, that is, phenotypically normal patients. The medical records of 29 non-HIV/nontransplant patients with cryptococcal disease during the period 2007-2014 were retrospectively reviewed. The most common site of infection was the central nervous system (n = 25, 86.2%), followed by the pulmonary system (n = 11, 37.9%) and blood (n = 2, 6.8%). Thoracic- and brain-computed tomography demonstrated abnormalities of 81.2% (n = 13) and 62.5% (n = 15), respectively. In sum, 22% (n = 6) of the patients experienced a significant underlying condition. More than one therapeutic regimen was used in 77.8% (n = 21) of the patients. The isolates were identified as being Cryptococcus neoformans species complex (n = 4, 36.4%) and Cryptococcus gattii species complex (n = 7, 63.6%). The overall mortality was 20.7% (n = 6). Herein, we presented the first case series of cryptococcosis in this specific population in São Paulo City, Brazil. The incidence of cryptococcosis in our hospital has not increased in recent years, and 77.8% (n = 21) of cases had no obvious predisposing factor. However, this disease remains associated with high mortality.
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Criptococose/patologia , Cryptococcus/isolamento & purificação , Adolescente , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Brasil/epidemiologia , Infecções Fúngicas do Sistema Nervoso Central/epidemiologia , Infecções Fúngicas do Sistema Nervoso Central/patologia , Criança , Pré-Escolar , Criptococose/diagnóstico por imagem , Criptococose/epidemiologia , Criptococose/microbiologia , Cryptococcus/classificação , Feminino , Fungemia/epidemiologia , Fungemia/patologia , Humanos , Pneumopatias Fúngicas/epidemiologia , Pneumopatias Fúngicas/patologia , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Estudos Retrospectivos , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
Introduction: Syphilis was an important cause of ocular inflammation during the pre-antibiotic era. Nowadays, its prevalence has clearly diminished and, although there has been an arousal of its manifestations in the Central Nervous System, mostly among HIV (+) patients; ocular compromise, particularly optic neuritis, are still infrequent. Nevertheless, the consequences of a late medical treatment maintain the importance of considering this diagnosis as an option in many clinical scenarios. Method: Review of the actual literature from the experience of two cases we recently treated. Discussion: We present the physiopathology clinical manifestations, diagnosis and treatment of syphilis, specifically its neurological and ocular manifestations in HIV and no HIV patients, discussing whether is necessary to actively search for syphilis in patients consulting with optic neuritis. Conclusion: As VDRL is an accessible exam for the differential diagnostic of syphilis in patients cursing with optic neuritis, we propose to practice it always in every patient, we suspect this pathology.
Introducción: La sífilis fue en la época preantibiótica causa frecuente de inflamación ocular. Actualmente su prevalencia ha disminuido, y si bien hemos visto una recrudescencia de sus manifestaciones en el sistema nervioso central asociada a la enfermedad por VIH, las manifestaciones oculares, particularmente la Neuritis Óptica, siguen siendo muy infrecuentes. Sin embargo, las consecuencias del retraso de tratamiento antibiótico oportuno, obligan al médico a tener presente este diagnóstico en diversos escenarios clínicos. Método: Revisión bibliográfica a partir de la descripción de dos casos que tratamos recientemente. Discusión: Exponemos la fisiopatología, clínica, diagnóstico y tratamiento de la sífilis con consideraciones especiales en sus manifestaciones neurológicas y oftalmológicas, en paciente VIH como no VIH, discutiendo si es necesario buscar activamente la sífilis en casos de Neuritis Óptica. Conclusión: El VDRL como herramienta para realizar el diagnóstico diferencial en un cuadro de Neuritis Óptica es un examen accesible para el clínico, por lo que proponemos solicitarlo de rutina en todo paciente que presente esta patología.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Neurite Óptica/etiologia , Sífilis/complicações , Sífilis/diagnóstico , Antibacterianos/uso terapêutico , Sífilis/fisiopatologia , Sífilis/tratamento farmacológicoRESUMO
BACKGROUND: HIV/AIDS is a problem in developing countries including Jamaica. There are several studies dealing with HIV/AIDS in Jamaica but given the increasing rate of the infection, ongoing studies are necessary. AIMS: This study examines the sexual behavior and attitude of non-HIV testers in Jamaica in order to provide research evidence that will direct public health policies and interventions. MATERIALS AND METHODS: This study extracts a sample of 1,192 participants who indicated not having done a HIV test from 1,800 respondents from a 2004 HIV/AIDS/STD National KABP Survey. A detailed questionnaire was developed and used to collect data from people ages 15-49 years old. RESULTS: Some 20.3 % of the variances, which is self reported positive HIV test results, are a function of relationship status, using protection against HIV, having sex with a commercial sex worker, having STIs, the age at which the participant first had sex and age at last birthday. These findings hold across gender, occupational status and education. The majority (87.9%) of the participants said they had little or no chance of getting HIV, and 59.7% did not want to know their HIV status. However, 46.6% did not wear a condom the first time they had sex with current partner, 32% do not wear a condom with their current partner and 16.3% reported having had STIs. CONCLUSION: The existing HIV prevention programs need to be expanded and fortified to target young Jamaicans, particularly those who do not engage in safe sexual practices.