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Introdução: A tuberculose (TB) é considerada uma doença bem desafiadora para o sistema de saúde no Brasil, devido ao número elevado de casos nas últimas décadas. Contudo, com a pandemia da COVID-19, foi observada uma redução significativa de casos de TB. Objetivo: O objetivo desse trabalho foi avaliar o comportamento da TB nas macrorregionais de saúde do estado do Paraná, bem como nas populações vulneráveis nos anos de 2011 a 2021, e sua associação com a ocorrências de casos de COVID-19 a partir de 2020. Metodologia: Trata-se de um estudo ecológico, com dados secundários de TB do Sistema de Informação de Agravos de Notificação (SINAN) e de COVID-19 no banco de dados público oficial da Secretaria de Estado da Saúde do Paraná (SESA) para o coronavírus. Principais resultados: Foi observada diferenças significativas de ocorrência de casos de TB entre as macrorregionais relacionadas à faixa etária da população e entre os períodos pré-pandêmico e pandêmico no Paraná. Os dados obtidos apontam também para uma associação significativa de casos de TB em populações em situação de rua, privadas de liberdade e portadores do vírus da imunodeficiência humana (HIV) no estado ao longo dos anos observados. Conclusão: As notificações de TB no estado do Paraná foram afetadas pela pandemia da COVID-19.
Introduction: Tuberculosis (TB) is considered a very challenging disease for the health system in Brazil, due to the high number of cases in recent decades. However, with the COVID-19 pandemic, a significant reduction in TB cases was observed. Objective: The objective of this study was to evaluate the behavior of TB in the macro-regional health regions of the state of Paraná, as well as in vulnerable populations in the years 2011 to 2021 and the association with the occurrence of COVID-19 cases from 2020. Methodology: Its an ecological study with secondary tuberculosis data from SINAN and data COVID-19 in the official public database of the Paraná State Health Department (SESA). Results: Results show significant differences of TB cases among the macro-regions related to the age group of the population and between the pre-pandemic and pandemic periods. A significant association of TB cases was also observed for the homeless, deprived of liberty and HIV-positive populations in the state over the years observed. Conclusion: TB notifications in the state of Paraná were affected by the COVID-19 pandemic.
Introducción: La tuberculosis (TB) es considerada una enfermedad muy desafiadora para el sistema de salud en Brasil, debido al elevado número de casos en las últimas décadas. Sin embargo, con la pandemia de COVID-19, se observó una reducción significativa de los casos de TB. Objetivo: El objetivo de este estudio fue evaluar el comportamiento de la TB en las macro regiones sanitarias del estado de Paraná, así como en poblaciones vulnerables en los años 2011 a 2021 y la asociación con la ocurrencia de casos de COVID-19 a partir de 2020. Metodología: Es un estudio ecológico con datos secundarios de tuberculosis del SINAN y datos COVID-19 en la base de datos pública oficial de la Secretaría de Salud del Estado de Paraná (SESA). Resultados: Los resultados muestran diferencias significativas de casos de TB entre las macrorregiones relacionadas con el grupo de edad de la población y entre los períodos prepandémico y pandémico. También se observó una asociación significativa de casos de TB para la población sin hogar, privada de libertad y seropositiva al VIH en el estado a lo largo de los años observados. Conclusiones: Las notificaciones de TB en el estado de Paraná fueron afectadas por la pandemia de COVID-19.
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Opportunistic infections are serious complications in critically ill COVID-19 patients, especially co-infections with bacterial and fungal agents. Here we report a rare case of bloodstream co-infection by Trichosporon asahii, an emerging yeast, and Acinetobacterbaumannii, an opportunistic nosocomial pathogen, both multidrug resistant, in a tertiary hospital from southern Brazil. A review of the literature regarding similar cases is also included. Treatment with multiple antimicrobials failed, and the patient progressed to death four days after the diagnosis of bacteremia and fungemia.
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COVID-19 , Coinfecção , Micoses , Sepse , Trichosporon , Antifúngicos/uso terapêutico , Basidiomycota , COVID-19/complicações , Coinfecção/diagnóstico , Coinfecção/tratamento farmacológico , Humanos , Micoses/diagnóstico , Sepse/microbiologiaRESUMO
RESUMEN Introducción: La leucoencefalopatía multifocal progresiva es una enfermedad desmielinizante del sistema nervioso central, de etiología viral. Se presenta en pacientes con enfermedades inmunosupresoras y la localización en fosa posterior es rara. Debido a sus formas clínicas inespecíficas se hace infrecuente su diagnóstico lo que conlleva a daño irreversible y/o a la muerte del paciente. Objetivo: Orientar sobre la posibilidad de leucoencefalopatía multifocal progresiva cerebelosa en pacientes inmunodeprimidos con manifestaciones neurológicas de daño en fosa posterior. Caso clínico: Paciente masculino, de 25 años de edad, sin antecedentes de enfermedades aparentes, que comienza con lenguaje escandido, temblor mixto dismetría y ataxia. Se diagnostica leucoencefalopatía multifocal progresiva cerebelosa por cuadro clínico, neuroimagen y presencia de virus JC en líquido cefalorraquídeo, además de una inmunosupresión severa causada por virus de inmunodeficiencia humana diagnosticado por pruebas serológicas. Conclusiones: Considerar leucoencefalopatía multifocal progresiva cerebelosa en todo paciente con manifestaciones neurológicas de afectación en fosa posterior y estudiar causas de inmunosupresión subyacente.
ABSTRACT Introduction: Progressive multifocal leukoencephalopathy is a demyelinating disease of viral etiology that affects the central nervous system. It presents in patients with immunosuppressive conditions and location in the posterior fossa is rare. Due to its unspecific clinical forms, its diagnosis is infrequent, leading to irreversible damage and/or the patient's death. Objective: Instruct about the possibility of cerebellar progressive multifocal leukoencephalopathy in immunocompromised patients with neurological manifestations of posterior fossa damage. Clinical case: A case is presented of a male 25-year-old patient without apparent pathological antecedents who started out with slurred speech, mixed tremor, dysmetria and ataxia. Cerebellar progressive multifocal leukoencephalopathy was diagnosed by clinical picture, neuroimaging and the presence of JC virus in the cerebrospinal fluid, alongside severe immunosuppression caused by human immunodeficiency virus diagnosed by serological testing.
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Nocardia is a ubiquitous microorganism related to pyogranulomatous infection, which is difficult to treat in humans and animals. The occurrence of the disease is on the rise in many countries due to an increase in immunosuppressive diseases and treatments. This report of cases from Brazil presents the genotypic characterization and the antimicrobial susceptibility pattern using the disk-diffusion method and inhibitory minimal concentration with E-test® strips. In summary, this report focuses on infections in young adult men, of which three cases were cutaneous, two pulmonary, one neurological and one systemic. The pulmonary, neurological and systemic cases were attributed to immunosuppressive diseases or treatments. Sequencing analysis of the 16S rRNA segments (1491 bp) identified four isolates of Nocardia farcinica, two isolates of Nocardia nova and one isolate of Nocardia asiatica. N. farcinica was involved in two cutaneous, one systemic and other pulmonary cases; N. nova was involved in one neurological and one pulmonary case; and Nocardia asiatica in one cutaneous case. The disk-diffusion antimicrobial susceptibility test showed that the most effective antimicrobials were amikacin (100%), amoxicillin/clavulanate (100%), cephalexin (100%) and ceftiofur (100%), while isolates had presented most resistance to gentamicin (43%), sulfamethoxazole/trimethoprim (43%) and ampicillin (29%). However, on the inhibitory minimal concentration test (MIC test), only one of the four isolates of Nocardia farcinica was resistant to sulfamethoxazole/trimethoprim.
Nocardia é um microorganismo ubiquitário relacionado a infecções piogranulomatosas, com difícil resolução tecidual em humanos e animais. A doença é mundialmente emergente devido ao aumento de doenças e tratamentos imunossupressores. Este relato de casos ocorridos no Brasil visa apresentar a identificação molecular dos isolados e o padrão de sensibilidade a antimicrobianos por disco-difusão e concentração inibitória mínima (CIM) através de fitas E-test®. Os casos ocorreram em homens, em idade adulta. Três quadros foram cutâneos, dois pulmonares, um neurológico e um sistêmico. O quadro respiratório, o neurológico e um sistêmico estavam associados à doença ou terapia imunossupressoras. O sequenciamento do gene 16S rRNA (1491pb) possibilitou a identificação de quatro isolados de Nocardia farcinica, dois de Nocardia nova e um de Nocardia asiatica. N. farcinica foi observada em dois casos dermatológicos, um pulmonar e um quadro sistêmico, N. nova foi isolada de um caso neurológico e outro pulmonar; e N. asiatica em um caso dermatológico. O teste de disco-difusão mostrou que amicacina (100%), amoxicilina/clavulanato (100%), cefalexina (100%) e ceftiofur (100%) foram mais efetivos; enquanto gentamicina (43%), sulfametoxazol/trimetoprim (43%) e ampicilina (29%) foram menos efetivos. No entanto, no teste de concentração inibitória mínima (CIM), apenas um dos quatro isolados da espécie Nocardia farcinica mostrou-se resistente a sulfametoxazole-trimetropina.
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Adulto , Animais , Humanos , Masculino , Antibacterianos/farmacologia , Nocardiose/microbiologia , Nocardia/genética , Técnicas de Tipagem Bacteriana , Brasil , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , DNA Bacteriano/genética , Nocardia/classificação , Nocardia/isolamento & purificação , /genéticaRESUMO
Disseminated histoplasmosis (DH) is the most current revelation mode of AIDS in French Guiana. We describe the clinical and paraclinical presentation of DH, diagnostic tools, evolution and factors associated with 1-year mortality in HIV-infected patients from western French Guiana. Microbiologically proven AIDS-related DH in Saint Laurent du Maroni's hospital between May 2002 and May 2012 were retrospectively included. Among the 82 patients included, 58 (71%) were male, 44 (53%) presented concurrent histoplasmosis and HIV diagnosis and 63 (80%) had a CD4 cell count under 50 cells µL(-1). Almost all patients had weight loss (97%) and fever (95%), while 84% had digestive symptoms (63% diarrhoea), 55% lymphadenopathy, and 49% respiratory symptoms. Documented and presumed locations of H. capsulatum var capsulatum (Hcc) concerned almost all organs, with a particular affinity for the bone marrow and the digestive system. Co-infections were associated in 65%. Following treatment initiation, 10 patients (13%) died within 1 month and 17 patients (25%) died within a year. DH is a polymorphous systemic mycosis with haematological and digestive tropism. Co-infections are frequent and mortality rate is high.
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Infecções Oportunistas Relacionadas com a AIDS , Histoplasma/isolamento & purificação , Histoplasmose , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Adulto , Medula Óssea/microbiologia , Contagem de Linfócito CD4 , Coinfecção , Diarreia , Feminino , Febre , Guiana Francesa , Trato Gastrointestinal/microbiologia , Histoplasmose/diagnóstico , Histoplasmose/mortalidade , Humanos , Doenças Linfáticas/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Redução de PesoRESUMO
To the best of our knowledge, no Chinese case studies concerning Nocardia infection have been published to date. Therefore, the present study aimed to retrospectively evaluate the risk factors, clinical features, imaging results, laboratory abnormalities, treatments and outcomes of nocardiosis in a Chinese tertiary hospital. Data collected from patients with laboratory-confirmed nocardiosis were retrospectively analyzed. A total of 40 patients who had a positive culture of Nocardia were included. The median time between the onset of symptoms and diagnosis was 42 days. Underlying diseases were identified in 72.5% of the patients of which diabetes was the most common (32.5%). The most important risk factor was corticosteroid administration. Fever and cough were common clinical symptoms. The pleuropulmonary (85%) were the most frequently involved sites and the disseminated disease rate was 30.0%. Frequent chest computed tomography scans revealed the presence of airspace opacities, nodules and masses, in addition to cavitary lesions that were particularly common among the study group. Brain images revealed lesions associated with abscesses. The majority of the patients (71.1%) were treated with trimethoprim sulfamethoxazole alone or in combination with other drugs. The in-hospital mortality rate was 15.0%. Disseminated disease, immunocompromised patients, an older age, brain involvement and concomitant infections were associated with a poor prognosis. Nocardiosis is an uncommon but emerging disease. The present study reports the first case series on nocardiosis from China and provides important information on the clinical features and risk factors of nocardiosis. Early recognition of the disease and the initiation of appropriate treatment are essential for a good prognosis.
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Describir las características epidemiológicas y clínicas de los pacientes hospitalizados con SIDA en el Hospital Central "Dr. Miguel Pérez Carreño" (HMPC) entre 2004 y 2008. Métodos: Selección y revisión de historias clínicas del archivo del hospital en función a los criterios de inclusión y exclusión y variables epidemiológicas y clínicas definidas. Resultados: 150 casos cumplieron con los criterios de inclusión, de los cuales 112 (75%) eran pacientes del género masculino. Las enfermedades asociadas a SIDA más destacadas halladas son: 39 (26%) casos de enfermedades del sistema nervioso central (SNC), 37 (25%) casos de enfermedades pulmonares, 25 (17%) casos de enfermedades gastrointestinales, 15 (10%) casos de enfermedades de piel y mucosas 12 (8%) casos de enfermedades infecciosas sistémicas. 71 (47%) pacientes tuvieron contaje de células T CD4+ <100, 56 (37%) entre 100 y 499 y 1 (1%) > 500. 77 (51%) tuvieron carga viral < 150.000. En lo que respecta al uso de drogas antirretrovirales, 88 (59%) eran usuarios de análogos nucleósidos de la transcriptasa reversa, 46 (31%) de inhibidores de la proteasa, 5 (3%) de análogos no nucleósidos de la transcriptasa reversa (NNRTI) y 1 (1%) de antagonistas del ácido fólico. Conclusiones: Los pacientes con SIDA experimentan un amplio espectro de enfermedades oportunistas en relación a lo avanzado de la enfermedad. Una de las características de la muestra estudiada fue que los pacientes que acuden a la emergencia del Hospital Dr. Miguel Pérez Carreño, llegan con un gran deterioro físico, con múltiples complicaciones y cargas virales sumamente elevadas y contaje de T CD4+ < 100(AU)
Selection and review of the medical records from the hospital archives according to exclusion and inclusion criteria and established epidemiologic and clinical variables. Results: Inclusion criteria were met by 150 patients, from which 112 (75%) were male. Concurrent disorders were: 39 (26%) cases of diseases of the central nervous system (SNC), pulmonary 37 cases (25%), gastrointestinal 25 cases (17%), skin and soft tissues 15 cases (10%), systemic infectious diseases 12 cases (8%). Regarding T-cell count, 71 patients (47%) had CD4+ <100, 56 patients (37%) had CD4+ ranging from 100 and 499 and 1 patient (1%) had CD4+ >500. Viral load <150.000 was found in 77 patients (51%). As to the use of anti-retroviral drugs, 88 patients (59%) were taking nucleoside reverse transcriptase inhibitors (NRTI), 46 patients (31%) were taking protease inhibitors, 5 patients (3%) were taking reverse non-nucleoside reverse transcriptase inhibitors (NNRTI) and 1 patient (1%) was taking a folic acid antagonist. Conclusions: Patients with AIDS suffer from a wide range of opportunistic disorders related to the progression of the underlying disease. One of the main characteristics of the patients studied was the poor physical condition showed when they arrive to the Hospital´s Emergency Room. They were admitted because of multiple complications, extremely high viral loads and T-Cell CD4+ <100, which translates into a profound immunologic compromise and a variety of opportunistic diseases(AU)
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Central , Síndrome da Imunodeficiência Adquirida/epidemiologia , Gastroenteropatias , Pneumopatias , Sarcoma de Kaposi , Doenças Transmissíveis , Infectologia , Doenças do Sistema ImunitárioRESUMO
Las complicaciones neurológicas son frecuentes en los pacientes afectados por el virus de inmunodeficiencia humana (VIH). Se realizó un estudio descriptivo, retrospectivo, para conocer la frecuencia de la patología neurológica en los pacientes VIH/SIDA (síndrome de inmunodeficiencia adquirida) de nuestro centro, su perfil clínico y evolutivo, comparar el grado de inmunodepresión, el tiempo de estadía hospitalaria, la gravedad de la afección (estimada por requerimiento de ingreso a CTI) y la mortalidad entre los pacientes que se presentaban con enfermedades oportunistas (EO) y enfermedades no oportunistas (ENO). Se encontró una alta prevalencia de enfermedad neurológica (21%), en población joven, en su mayoría de sexo masculino, con inmunodepresión muy severa, predominando la etapa SIDA; las EO son las más frecuentes y registran mayor morbimortalidad que las ENO. Nuestra población no registra la transición epidemiológica del mundo desarrollado vinculado al uso de terapia antirretroviral (TARV), hecho que atribuímos a sus condiciones socio-económico-culturales.
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Humanos , Masculino , Feminino , Adulto Jovem , Adulto , HIV , Síndrome da Imunodeficiência Adquirida/complicações , Terapia Antirretroviral de Alta Atividade , Infecções Oportunistas Relacionadas com a AIDS , Doenças do Sistema Nervoso/etiologia , Epidemiologia , Infecções BacterianasRESUMO
Resumen: Arch Med Interna 2013 - 35(1):05-08 Las complicaciones neurológicas son frecuentes en los pacientes afectados por el virus de inmunodeficiencia humana (VIH). Se realizó un estudio descriptivo, retrospectivo, para conocer la frecuencia de la patología neurológica en los pacientes VIH/SIDA (síndrome de inmunodeficiencia adquirida) de nuestro centro, su perfil clínico y evolutivo, comparar el grado de inmunodepresión, el tiempo de estadía hospitalaria, la gravedad de la afección (estimada por requerimiento de ingreso a CTI) y la mortalidad entre los pacientes que se presentaban con enfermedades oportunistas (EO) y enfermedades no oportunistas (ENO). Se encontró una alta prevalencia de enfermedad neurológica (21%), en población joven, en su mayoría de sexo masculino, con inmunodepresión muy severa, predominando la etapa SIDA; las EO son las más frecuentes y registran mayor morbimortalidad que las ENO. Nuestra población no registra la transición epidemiológica del mundo desarrollado vinculado al uso de terapia antirretroviral (TARV), hecho que atribuímos a sus condiciones socio-económico-culturales.
Abstract: Arch Med Interna 2013 - 35(1):05-08 Neurological complications are common in patients with human immunodeficiency virus (HIV). We conducted a descriptive study, to determine the frequency of neurological disease in HIV/AIDS (acquired immunodeficiency syndrome) in our center, their clinical and developmental profile, and compare the degree of immunosuppression, the length of hospital stay, severity of the condition (estimated income requirement to intensive care unit [ICU]) and mortality between the patients presenting with opportunistic disease (OD) and non-opportunistic disease (NOD). High prevalence of neurological disease (21%) was found, mostly in young people, male, with severe immunosuppression, dominating the AIDS stage. ODs are more frequent and have higher recorded morbidity than NOD. Our population does not record the epidemiological transition seen in the developed world linked to the use of antiretroviral therapy (ART), a fact we attribute to the socio-economic-cultural situation.
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INTRODUÇÃO: Desde o início da epidemia de HIV no Ceará, histoplasmose disseminada tem sido detectada com frequência em pacientes com aids. MÉTODOS: De modo a conhecer características clínico-laboratoriais, evolução e sobrevida da co-infecção HD/AIDS, analisou-se retrospectivamente 134 prontuários casos de HD internados de 1999 a 2005 no hospital referência para HIV no Ceará. RESULTADOS: Pacientes com HD apresentaram maior frequência de febre diária, tosse, perda de peso, hepatoesplenomegalia e insuficiência renal aguda. Diagnóstico foi dado por pesquisa e/ou cultura. À admissão, foram fatores de risco relacionados ao óbito de pacientes com HD: vômitos, dispnéia, insuficiência respiratória e IRA, hemoglobina<8g/L, uréia>40mg/dL e creatinina >1,5mg/dL. CONCLUSÕES: pacientes com HD apresentaram caracteristicamente febre mais elevada, internamentos anteriores por infecção respiratória, mais complicações clínicas e como fatores independentes para óbito, anemia importante e elevação de uréia.
INTRODUCTION: Since the beginning of the HIV epidemic in Ceará, disseminated histoplasmosis (DH) has often been detected among AIDS patients. METHODS: In order to investigate the clinical and laboratory characteristics, evolution and survival of cases of DH/AIDS coinfection, the medical records on 134 cases of DH admitted to a reference hospital in Ceará between 1999 and 2005 were analyzed. RESULTS: Patients with DH presented higher frequency of daily fever, coughing, weight loss, enlarged liver and spleen and acute kidney failure. The diagnosis was made using investigation and/or cultures. At admission, the following were risk factors for death among DH patients: vomiting, dyspnea, respiratory failure, acute kidney failure, hemoglobin < 8g/l, urea > 40mg/dl and creatinine >1.5 mg/dl. CONCLUSIONS: Patients with DH characteristically presented higher fever, previous hospitalization due to respiratory infection and more clinical complications. Significant anemia and elevated urea were independent risk factors for death among DH patients.
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Adulto , Feminino , Humanos , Masculino , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Histoplasmose/mortalidade , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Brasil/epidemiologia , Histoplasmose/complicações , Histoplasmose/tratamento farmacológico , Estudos RetrospectivosRESUMO
A patient with HIV infection developed the first episode of AIDS-defining opportunism (severe Candida albicans esophagitis) with an underlying CD4+ lymphocyte count of 1,025 cells/µL. After treatment with a highly active antiretroviral therapy (HAART), taken with insufficient compliance and leaving a residual viral load, our patient suffered from two relapses of esophageal candidiasis, which occurred three months and seven years later, when his CD4+ lymphocyte count was 930 and 439 cells/µL, respectively, and a viral load slightly above 10(4) copies/mL was still present. Also in the HAART era, Candida esophagitis remains one of the most common AIDS-defining diseases, but a presentation with a concurrent CD4+ count above 1,000 cells/µL remains a rare exception, as well as the two isolated, subsequent relapses, occurred with a CD4+ count ranging from 439 to 930 cells/µL, and a residual HIV viremia due to insufficient adherence to the prescribed HAART regimens. Our case report represents the opportunity to revisit the epidemiology and, especially, the pathogenesis of this opportunistic fungal complication in HIV-infected patients and in other subjects at risk, on the ground of an extensive literature review, and to explore possible alternative supporting factors other than the crude absolute CD4+ lymphocyte count, with emphasis on the possible role of a persisting HIV viremia, and other potential contributing factors. Clinicians engaged with immunocompromised patients and subjects with HIV disease, should be aware that a Candida esophagitis may occur and relapse also when the cell-mediated immunity, as measured by a simple CD4+ cell count, do not show relevant abnormalities.