RESUMO
Stenotrophomonas maltophilia (S. maltophilia) is an intrinsically drug-resistant and biofilm-forming bacteria causing infections in immunocompromised humans. This study reports the isolation of five S. maltophilia strains from saliva and gingival crevicular fluid (GCF) of AIDS patients with periodontitis in São Paulo, Brazil, showing resistance to ceftazidime, strong biofilm formation capacity and a close genetic relationship. The presence of S. maltophilia strains in saliva and CGF of patients with AIDS and periodontitis is a concern for the presence and persistence of intrinsically resistant bacteria in the oral environment, enhancing the risk for the development of severe infections in immunocompromised patients.
Assuntos
Síndrome da Imunodeficiência Adquirida , Antibacterianos , Biofilmes , Ceftazidima , Líquido do Sulco Gengival , Infecções por Bactérias Gram-Negativas , Periodontite , Saliva , Stenotrophomonas maltophilia , Humanos , Stenotrophomonas maltophilia/efeitos dos fármacos , Stenotrophomonas maltophilia/genética , Stenotrophomonas maltophilia/isolamento & purificação , Brasil , Saliva/microbiologia , Periodontite/microbiologia , Líquido do Sulco Gengival/microbiologia , Líquido do Sulco Gengival/química , Ceftazidima/farmacologia , Antibacterianos/farmacologia , Infecções por Bactérias Gram-Negativas/microbiologia , Biofilmes/crescimento & desenvolvimento , Biofilmes/efeitos dos fármacos , Síndrome da Imunodeficiência Adquirida/microbiologia , Masculino , Adulto , Feminino , Testes de Sensibilidade Microbiana , Farmacorresistência Bacteriana , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Cryptococcus neoformans is an opportunistic pathogen that causes â¼15% mortality in AIDS patients. Rio Grande City, Rio Grande do Sul (RS), Brazil, has the highest national rate of HIV/AIDS, considering cities with population more than 100,000 habitants. OBJECTIVE: We aimed to evaluate the clinical and epidemiological profile of cryptococcosis in a reference service for HIV-AIDS patients in the South region of Brazil, over seven years. Material and methods A retrospective study was performed including all cryptococcosis cases diagnosed at the University Hospital, Federal University of Rio Grande (UH-FURG) between January 2010 and December 2016. RESULTS: Seventy cases of cryptococcosis were diagnosis from 2010 to 2016 in the UH-FURG in the seven years of the study. These numbers were responsible for 2.1% to 8.1% of the hospitalizations/year for HIV patients. All were caused by C. neoformans infection (95% C. neoformans var. grubii VNI and 5% C. neoformans var. grubii VNII). Neurocryptococcosis was the major clinical manifestation and cryptococcosis was the HIV- defining condition in 40% of patients. The period of hospitalization was an average of 39.3 days (SD=31.3), and more than half of patients (53%; 37/70) died after a mean of 82 days. DISCUSSION: The present study showed the importance of cryptococcosis as an AIDS-defining disease in HIV-AIDS patients in a tertiary hospital from Southern Brazil. More investment is necessary to reduce the impact of this opportunistic mycosis in HIV-AIDS patients from southern Brazil.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Criptococose/epidemiologia , Infecções por HIV/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/microbiologia , Adulto , Idoso , Brasil/epidemiologia , Criptococose/complicações , Criptococose/microbiologia , Cryptococcus neoformans/isolamento & purificação , Feminino , HIV , Infecções por HIV/complicações , Infecções por HIV/microbiologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Meningite Fúngica/epidemiologia , Meningite Fúngica/etiologia , Meningite Fúngica/microbiologia , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Análise de Sobrevida , Adulto JovemRESUMO
Paracoccidioidomycosis (Pm) is a systemic disease, endemic in the American continent. There are two different clinical forms, the infant-juvenile or subacute form (PmS) and the chronic adult form (PmC). The human immunodeficiency virus (HIV) associated paracoccidioidomycosis (PmHIV) shares characteristics with both of the previously mentioned forms. The objective of this work was to describe the epidemiological, clinical and laboratory features of the PmHIV and to compare them with the ones of PmS and the PmC. A retrospective analysis of 119 patients with paracoccidioidomycosis was performed. Ninety four suffered the chronic form, 11 the subacute one and 14 were coinfected with HIV. Patients with PmHIV presented a CD4+ T lymphocytes median of 70.5 cells/µl, 71.4% had fever, 64.3% had a miliary pattern on the chest radiography, 64.3% had hepatosplenomegaly, 64.3% had mucosal lesions and 50% had skin lesions. One patient died during his hospitalization. The clinical presentation of Pm in patients with HIV resembled the subacute form with fever, hepatomegaly and skin lesions. However, they also tended to present mucosal lesions, positive serology for Pm and pulmonary parenchyma lesions as usually seen in PmC (9/14 PmHIV patients had overlapping features, while 4/14 PmHIV patients clinically resembled PmS and 1/14 PmC). The incidence of Pm has not changed with the burden of AIDS as it has happened with other fungal infections but it appears clinically different from the classic clinical forms of the disease.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/microbiologia , Paracoccidioidomicose/microbiologia , Adulto , Antifúngicos/uso terapêutico , Argentina/epidemiologia , Linfócitos T CD4-Positivos , Feminino , Febre/microbiologia , Infecções por HIV/microbiologia , Hepatomegalia/microbiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Paracoccidioidomicose/tratamento farmacológico , Paracoccidioidomicose/epidemiologia , Radiografia , Estudos Retrospectivos , Tórax/diagnóstico por imagem , Tórax/microbiologiaAssuntos
Infecções por HIV/microbiologia , Pneumocystis carinii/isolamento & purificação , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Síndrome da Imunodeficiência Adquirida/microbiologia , Adulto , Estudos Transversais , DNA Fúngico/isolamento & purificação , Feminino , Humanos , Masculino , Peru , Pneumocystis carinii/genética , Reação em Cadeia da Polimerase/métodosRESUMO
BACKGROUND: Cryptococcal meningitis has a high morbidity and mortality among AIDS population. Cryptococcal antigen (CrAg) detection is considered an independent predictor for meningitis and death. Since 2011, the World Health Organization recommends CrAg screening for people living with HIV/AIDS (PLHAs) with CD4 counts <100-200 cells/µl. Its implementation is still limited in low-middle-income countries. We aimed to estimate the prevalence and predictors of CrAg positivity in PLHAs. We also evaluated outcomes among those who were CrAg-positive. METHODS: Prospective cohort conducted at an infectious diseases hospital, in Brazil. Adults with CD4 <200 cells/µl, without previous cryptococcal disease and regardless of symptoms, were enrolled from 2015 to 2018. CrAg tests were performed by LFA. Lumbar puncture was done in CrAg+ individuals and pre-emptive therapy was offered for those without meningitis. RESULTS: Of 214 individuals recruited, 88% were antiretroviral experienced, of which only 11.6% with viral suppression. Overall, CrAg prevalence was 7.9% (95% CI, 4.7-12.4). In CD4 ≤100 cells/µl group it was 7.5% (95% CI, 4.1-12.6) and 9.1% (95% CI, 3.4-19.0) in the group with CD4 101 to 199 cells/µl (p = 0.17). Prevalence in asymptomatic subjects was 5.3% (95% CI, 1.4-13.1). One among 17 CrAg+ participants had documented meningoencephalitis and no subclinical meningitis was detected. Adherence to pre-emptive treatment was 68.7% (11/16). There were no statistically significant differences in sociodemographic, clinical or laboratory characteristics to predict CrAg positivity. No case of cryptococcal disease was diagnosed among CrAg + subjects, followed by a median of 12 months. CONCLUSIONS: CrAg screening for severely immunosuppressed PLHAs in Brazil yielded a prevalence of 7.9%. No difference was found in the prevalence of CrAg stratified by CD4 values (CD4 <100 versus CD4 101-199 cells/µl). No clinical nor laboratory factors predicted CrAg positivity, corroborating the need for the implementation of universal CrAg screening for PLHAs with CD4 <200 cells/µl in similar settings.
Assuntos
Síndrome da Imunodeficiência Adquirida/microbiologia , Antifúngicos/uso terapêutico , Cryptococcus neoformans/imunologia , Fluconazol/uso terapêutico , Meningite Criptocócica/diagnóstico , Meningite Criptocócica/prevenção & controle , Adulto , Antígenos de Fungos/metabolismo , Brasil , Feminino , Humanos , Masculino , Meningite Criptocócica/imunologia , Pessoa de Meia-Idade , Pobreza , Pré-Medicação , Estudos Prospectivos , Resultado do TratamentoRESUMO
Cryptococcosis is a systemic mycosis with a chronic or subacute progression caused by the inhalation of dehydrated yeasts or basidiospores. The causative agents are C. gattii and C. neoformans. The latter is more commonly associated with cellular immunodeficiency and is not rare in patients with Acquired Immunodeficiency Syndrome (AIDS). Cryptococcosis is common in pregnant women with AIDS; however, it is uncommon for the placenta to be affected, with few reported cases in the literature. We present the case of a pregnant woman with AIDS who had placental and pulmonary cryptococcosis associated with fungemia, with a satisfactory clinical outcome obtained after therapy.
Assuntos
Síndrome da Imunodeficiência Adquirida/microbiologia , Criptococose/microbiologia , Fungemia/microbiologia , Pneumopatias Fúngicas/microbiologia , Doenças Placentárias/microbiologia , Complicações Infecciosas na Gravidez/microbiologia , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/virologia , Humanos , Recém-Nascido , Masculino , Sepse Neonatal/tratamento farmacológico , Doenças Placentárias/patologia , Gravidez , Complicações Infecciosas na Gravidez/patologia , Adulto JovemAssuntos
Adulto , Feminino , Humanos , Masculino , Infecções por HIV/microbiologia , Pneumocystis carinii/isolamento & purificação , Peru , DNA Fúngico/isolamento & purificação , Reação em Cadeia da Polimerase/métodos , Estudos Transversais , Síndrome da Imunodeficiência Adquirida/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Pneumocystis carinii/genéticaRESUMO
Various infectious diseases can hyper-stimulate the immune system, causing hemophagocytic syndrome (HPS). Little is known regarding the accuracy of diagnostic criteria and epidemiological triggering factors in the acquired immunodeficiency syndrome (AIDS) setting. We investigated the major infectious disease triggers of HPS in patients living with human immunodeficiency virus (HIV)/AIDS and determined the accuracy of bone marrow aspiration (BMA). The inclusion criteria were (i) confirmed HIV diagnosis, (ii) bone marrow aspiration, and (iii) a minimum of four HPS criteria. Patients were further classified into those with four presumed HPS criteria, or ≥ 5 confirmed criteria. The disease triggers, accuracy of bone marrow aspiration, and prognosis markers were examined. Presumed HPS was observed in 15/36 patients (41%), and confirmed HPS in 58% (n = 21). The major etiological triggers were infection with Mycobacterium (34%), Cytomegalovirus (14%), Cryptococcus neoformans (11%), and hematological or tumoral disease (11%). BMA demonstrated 93% specificity on screening diagnosis (odds ratio [OR] 12.7, 95% confidence interval [CI] 1.4-115.1, P = 0.01). Ferritin > 5000 ng/mL correlated with probability of death in univariate analysis (OR 6.00, 95% CI 1.33-27.05, P = 0.02). Ferritin performance as test of death probability presented area under the curve as 0.74 (95% CI 0.56-0.91, P = 0.016). However, neither cluster of differentiation for lymphocyte count nor HIV viral load correlated with patient deaths. Mycobacterium spp. and Cytomegalovirus were the main factors triggering HPS, followed by Cryptococcus neoformans, and hematological and tumoral diseases. High ferritin levels were associated with increased death probability. High specificity was noted with BMA.
Assuntos
Síndrome da Imunodeficiência Adquirida , Linfo-Histiocitose Hemofagocítica , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/microbiologia , Síndrome da Imunodeficiência Adquirida/patologia , Síndrome da Imunodeficiência Adquirida/virologia , Adulto , Medula Óssea/metabolismo , Medula Óssea/microbiologia , Medula Óssea/patologia , Medula Óssea/virologia , Criptococose/epidemiologia , Criptococose/microbiologia , Criptococose/patologia , Criptococose/virologia , Cryptococcus neoformans , Citomegalovirus , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/microbiologia , Infecções por Citomegalovirus/patologia , Infecções por Citomegalovirus/virologia , Feminino , HIV-1 , Humanos , Linfo-Histiocitose Hemofagocítica/epidemiologia , Linfo-Histiocitose Hemofagocítica/microbiologia , Linfo-Histiocitose Hemofagocítica/patologia , Linfo-Histiocitose Hemofagocítica/virologia , Masculino , Mycobacterium , Infecções por Mycobacterium/epidemiologia , Infecções por Mycobacterium/microbiologia , Infecções por Mycobacterium/patologia , Infecções por Mycobacterium/virologia , Estudos RetrospectivosRESUMO
Rhodococcus equi is a facultative aerobic, intracellular, non-motile, non-spore-forming, Gram-positive, weakly acid-fast coccobacillus belonging to the group of nocardioform actinomycetes. R. equi infections are rare opportunistic illnesses in patients with Acquired Immunodeficiency Syndrome (AIDS), associated with a high mortality rate. The most common clinical presentation of R. equi infections is a chronic cavitary pneumonia. Due to its acid-fastness, R. equi can be mistaken for others acid-fast organisms, as Mycobacterium tuberculosis. In turn, R. equi is also a gram-positive pleomorphic bacteria and can be mistaken for diphtheroids or Micrococcus organisms, being accidentally disregarded as oral contaminants in sputum cultures. Therefore, in Brazil, a highly prevalent tuberculosis (TB) country, pulmonary infections caused by R. equi may mimic pulmonary TB and represent a diagnostic challenge. Here, we report on a case of chronic cavitary pneumonia by R. equi in a Human Immunodeficiency Virus (HIV)-infected patient, focusing on diagnostic aspects.
Assuntos
Síndrome da Imunodeficiência Adquirida/microbiologia , Infecções por Actinomycetales/microbiologia , Pneumonia Necrosante/microbiologia , Rhodococcus equi , Síndrome da Imunodeficiência Adquirida/diagnóstico , Infecções por Actinomycetales/diagnóstico , Doença Crônica , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Necrosante/diagnósticoRESUMO
INTRODUCCIÓN: La histoplasmosis es una micosis sistémica frecuente en pacientes inmunocomprometidos. La clínica es variable y se considera la micosis respiratoria más frecuente a nivel mundial, presentando mayor prevalencia en zonas tropicales incluida Sur América. Se estima que existen cuarenta millones de enfermos, calculándose doscientos mil nuevos casos anualmente. En Ecuador se desconoce la epidemiología de la enfermedad pero se calcula que el 11.1 % de pacientes con SIDA tienen histoplasmosis. CASO CLÍNICO: Paciente masculino de 23 años, procedente del Oro - Ecuador, con antecedentes de SIDA diagnosticado hace cuatro años, con mala adherencia al tratamiento antirretroviral y tuberculosis pulmonar, es ingresado por presentar fiebre de dos semanas de evolución, astenia, tos productiva, pérdida de peso, pápulas eritemato-violáceas costrosas diseminadas en todo el tegumento, con afectación mucosa. Los factores de riesgo que presentó el paciente para histoplasmosis la falta de cumplimiento al tratamiento antirretroviral y vivir en un área rural con exposición a excrementos de aves de corral. EVOLUCIÓN: El paciente fue hospitalizado con diagnóstico de histoplasmosis cutánea diseminada, SIDA, tuberculosis pulmonar, candidiasis oral y herpes anal. Se continuó con el tratamiento antirretroviral, antituberculoso e inició Anfotericina-B e Itraconazol; posteriormente el paciente fue dado de alta con mejoría clínica. CONCLUSIÓN: Las dermatosis juegan un papel importante para realizar el diagnóstico precoz de histoplasmosis. Cuando existen comorbilidades asociadas a la enfermedad, como el SIDA y tuberculosis pulmonar, es necesario replantear el tratamiento, por la interacción medicamentosa que puede existir entre el Itraconazol y la Rifampicina. El paciente recibió AnfotericinaB hasta presentar mejoría clínica. Para la prevención de enfermedades oportunistas una correcta adhesión al tratamiento antirretroviral, evitar el hábitat del hongo como criaderos de aves o cuevas y ante el riesgo de exposición, el uso adecuado de mascarilla.
BACKGROUND: Histoplasmosis is a frequent systemic mycosis in immunocompromised patients. The clinic is variable and is considered the most common respiratory mycosis worldwide, presenting a higher prevalence in tropical areas including South America. It is estimated that there are forty million patients, calculating two hundred thousand new cases annually. In Ecuador, the epidemiology of the disease is unknown, but it is estimated that 11.1% of patients with AIDS have histoplasmosis. CASE REPORT: Male patient of 23 years old, from Oro - Ecuador, with a history of AIDS diagnosed four years ago, with poor adherence to antiretroviral treatment and pulmonary tuberculosis, is admitted for presenting fever of two weeks evolution, asthenia, productive cough, weight loss, scaly erythematous-violaceous papules spread throughout the integument, with mucosal involvement. The risk factors presented by the patient for histoplasmosis were the lack of compliance with antiretroviral treatment and living in a rural area with exposure to poultry excrement. EVOLUTION: The patient was hospitalized with diagnosis of disseminated cutaneous histoplasmosis, AIDS, pulmonary tuberculosis, oral candidiasis and anal herpes. Antiretroviral, antituberculous treatment was continued and Amphotericin-B and itraconazole were started; later the patient was discharged with clinical improvement. CONCLUSION: Dermatoses play an important role in the early diagnosis of histoplasmosis. When there are comorbidities associated with the disease, such as AIDS and pulmonary tuberculosis. It is necessary to rethink the treatment, due to the drug interaction that may exist between Itraconazole and Rifampicin. The patient received Amphotericin-B until clinical improvement. For the prevention of opportunistic diseases, a correct adherence to the antiretroviral treatment, avoid the habitat of the fungus as bird or cave farms and before the risk of exposure, the adequate use of a mask.
Assuntos
Humanos , Masculino , Infecções Bacterianas e Micoses/transmissão , Síndrome da Imunodeficiência Adquirida/microbiologia , Histoplasmose/terapia , Infecções Oportunistas , HIVRESUMO
OBJECTIVE:: To evaluate the frequency of and factors associated with indeterminate interferon-gamma release assay (IGRA) results in people living with HIV/AIDS (PLWHA). METHODS:: We tested 81 PLWHA in the central-west region of Brazil, using the tuberculin skin test and an IGRA. Information on sociodemographic and clinical variables was gathered through the use of questionnaires and from medical records. The association of those variables with indeterminate results was analyzed by calculating the adjusted ORs in a multivariate logistic regression model. Concordance was evaluated by determining the kappa statistic. RESULTS:: Among the 81 patients evaluated, the tuberculin skin test results were positive in 18 (22.2%) of the patients, and the IGRA results were positive in 10 (12.3%), with a kappa of 0.62. The IGRA results were indeterminate in 22 (27.1%) of the patients (95% CI: 17.8-38.1%). The odds of obtaining indeterminate results were significantly higher in smokers (adjusted OR = 6.0; 95% CI: 1.4-26.7) and in samples stored for less than 35 days (adjusted OR = 14.0; 95% CI: 3.1-64.2). Patients with advanced immunosuppression (CD4+ T-cell count < 200 cells/mm3) were at a higher risk for indeterminate results (OR adjusted for smoking and inadequate duration of sample storage = 4.7; 95% CI: 0.91-24.0), although the difference was not significant. CONCLUSIONS:: The high prevalence of indeterminate results can be a major limitation for the routine use of IGRAs in PLWHA. The need to repeat the test increases its costs and should be taken into account in cost-effectiveness studies. The processing of samples can significantly alter the results. OBJETIVO:: Avaliar a frequência de resultados indeterminados de um interferon-gamma release assay (IGRA, ensaio de liberação de interferon-gama) e os fatores relacionados com esses resultados em pessoas vivendo com HIV/AIDS (PVHA). MÉTODOS:: Foram avaliadas 81 PVHA na região Centro-Oeste do Brasil, por meio do teste tuberculínico e de um IGRA. Informações a respeito de variáveis sociodemográficas e clínicas foram obtidas por meio de questionários e prontuários médicos. A relação entre essas variáveis e os resultados indeterminados foi avaliada por meio do cálculo da OR ajustada em um modelo de regressão logística multivariada. A concordância foi avaliada por meio do coeficiente kappa. RESULTADOS:: Os resultados do teste tuberculínico e do IGRA foram positivos em 18 (22,2%) e 10 (12,3%), respectivamente, dos 81 pacientes avaliados (κ = 0,62). O resultado do IGRA foi indeterminado em 22 (27,1%) dos pacientes (IC95%: 17,8-38,1%). A chance de resultados indeterminados foi significativamente maior em fumantes (OR ajustada = 6,0; IC95%: 1,4-26,7) e em amostras armazenadas durante menos de 35 dias (OR ajustada = 14,0; IC95%: 3,1-64,2). Pacientes com imunossupressão avançada (contagem de células T CD4+ < 200 células/mm3) apresentaram maior risco de resultados indeterminados (OR ajustada para tabagismo e tempo inadequado de armazenamento das amostras = 4,7; IC95%: 0,91-24,0), embora a diferença não tenha sido significativa. CONCLUSÕES:: A alta prevalência de resultados indeterminados pode ser um grande obstáculo ao uso rotineiro de IGRAs em PVHA. A necessidade de repetir o teste aumenta seu custo e deve ser levada em conta em estudos da relação entre custo e eficácia. O processamento das amostras pode alterar significativamente os resultados.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Testes de Liberação de Interferon-gama/métodos , Tuberculose Latente/diagnóstico , Tuberculose Latente/virologia , Síndrome da Imunodeficiência Adquirida/microbiologia , Adulto , Brasil , Contagem de Linfócito CD4 , Estudos Transversais , Estudos de Viabilidade , Feminino , Humanos , Período de Incubação de Doenças Infecciosas , Testes de Liberação de Interferon-gama/economia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários , Teste Tuberculínico/métodosRESUMO
ABSTRACT Objective: To evaluate the frequency of and factors associated with indeterminate interferon-gamma release assay (IGRA) results in people living with HIV/AIDS (PLWHA). Methods: We tested 81 PLWHA in the central-west region of Brazil, using the tuberculin skin test and an IGRA. Information on sociodemographic and clinical variables was gathered through the use of questionnaires and from medical records. The association of those variables with indeterminate results was analyzed by calculating the adjusted ORs in a multivariate logistic regression model. Concordance was evaluated by determining the kappa statistic. Results: Among the 81 patients evaluated, the tuberculin skin test results were positive in 18 (22.2%) of the patients, and the IGRA results were positive in 10 (12.3%), with a kappa of 0.62. The IGRA results were indeterminate in 22 (27.1%) of the patients (95% CI: 17.8-38.1%). The odds of obtaining indeterminate results were significantly higher in smokers (adjusted OR = 6.0; 95% CI: 1.4-26.7) and in samples stored for less than 35 days (adjusted OR = 14.0; 95% CI: 3.1-64.2). Patients with advanced immunosuppression (CD4+ T-cell count < 200 cells/mm3) were at a higher risk for indeterminate results (OR adjusted for smoking and inadequate duration of sample storage = 4.7; 95% CI: 0.91-24.0), although the difference was not significant. Conclusions: The high prevalence of indeterminate results can be a major limitation for the routine use of IGRAs in PLWHA. The need to repeat the test increases its costs and should be taken into account in cost-effectiveness studies. The processing of samples can significantly alter the results.
RESUMO Objetivo: Avaliar a frequência de resultados indeterminados de um interferon-gamma release assay (IGRA, ensaio de liberação de interferon-gama) e os fatores relacionados com esses resultados em pessoas vivendo com HIV/AIDS (PVHA). Métodos: Foram avaliadas 81 PVHA na região Centro-Oeste do Brasil, por meio do teste tuberculínico e de um IGRA. Informações a respeito de variáveis sociodemográficas e clínicas foram obtidas por meio de questionários e prontuários médicos. A relação entre essas variáveis e os resultados indeterminados foi avaliada por meio do cálculo da OR ajustada em um modelo de regressão logística multivariada. A concordância foi avaliada por meio do coeficiente kappa. Resultados: Os resultados do teste tuberculínico e do IGRA foram positivos em 18 (22,2%) e 10 (12,3%), respectivamente, dos 81 pacientes avaliados (κ = 0,62). O resultado do IGRA foi indeterminado em 22 (27,1%) dos pacientes (IC95%: 17,8-38,1%). A chance de resultados indeterminados foi significativamente maior em fumantes (OR ajustada = 6,0; IC95%: 1,4-26,7) e em amostras armazenadas durante menos de 35 dias (OR ajustada = 14,0; IC95%: 3,1-64,2). Pacientes com imunossupressão avançada (contagem de células T CD4+ < 200 células/mm3) apresentaram maior risco de resultados indeterminados (OR ajustada para tabagismo e tempo inadequado de armazenamento das amostras = 4,7; IC95%: 0,91-24,0), embora a diferença não tenha sido significativa. Conclusões: A alta prevalência de resultados indeterminados pode ser um grande obstáculo ao uso rotineiro de IGRAs em PVHA. A necessidade de repetir o teste aumenta seu custo e deve ser levada em conta em estudos da relação entre custo e eficácia. O processamento das amostras pode alterar significativamente os resultados.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Testes de Liberação de Interferon-gama/métodos , Tuberculose Latente/diagnóstico , Tuberculose Latente/virologia , Síndrome da Imunodeficiência Adquirida/microbiologia , Brasil , Contagem de Linfócito CD4 , Estudos Transversais , Estudos de Viabilidade , Período de Incubação de Doenças Infecciosas , Testes de Liberação de Interferon-gama/economia , Reprodutibilidade dos Testes , Inquéritos e Questionários , Teste Tuberculínico/métodosAssuntos
Síndrome da Imunodeficiência Adquirida/microbiologia , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/microbiologia , Meningite Criptocócica/tratamento farmacológico , Meningoencefalite/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Antifúngicos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Humanos , Medicina de Precisão/métodosRESUMO
Haemophagocytic lymphohistiocytosis is an uncommon syndrome that results from an uncontrolled activation of macrophages and lymphocytes resulting in the compromise of multiple organs that is potentially fatal without timely treatment. It can be hereditary or a secondary result of infectious processes, neoplasms or autoimmune conditions. We present the case of a patient with HIV/AIDS who developed hemophagocytic lymphohistiocytosis as well as disseminated intravascular coagulation associated with histoplasmosis and who was successfully treated with amphotericin B, steroids and transitory dialytic support.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Anfotericina B/farmacologia , Coagulação Intravascular Disseminada/complicações , Histoplasmose/complicações , Linfo-Histiocitose Hemofagocítica , Síndrome da Imunodeficiência Adquirida/microbiologia , Anfotericina B/química , Coagulação Intravascular Disseminada/microbiologia , Coagulação Intravascular Disseminada/virologia , Humanos , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/microbiologiaRESUMO
OBJECTIVE: To evaluate the added value of QuantiFERON TB-Gold in-Tube (QTF-GIT) over the tuberculin skin testing (TST) for detecting latent tuberculosis (TB) infection (LTBI) among patients with AIDS in a city with a low TB incidence rate (11.1/100,000 inhabitants) and universal BCG coverage. METHODS: Three hundred consecutive patients with AIDS in eight outpatient sexually transmitted disease public clinics in Brasilia were submitted to QFT-IT and TST between May 2011 and March 2013. A positive result of either test was considered to be LTBI. RESULTS: Median CD4-cell count was 477.5 cells/mm(3); 295 (98.3%) were using antiretroviral therapy. Eighteen patients (6%, 95% CI: 3.6%-9.3%) had LTBI, of whom 4 (1.3%, 95% CI: 0.04%-2.63%) had only a positive TST, 8 (2.7%, 95% CI: 0.8%-4.5%) had only a QFT-GIT positive test, and 6 (2%, 95% CI: 0.4%-3.6%) had positive results for both tests. This represents an 81.8% relative increase in LTBI detection when QFT-GIT is added to TST. The concordance between both tests was 96% (k = 0.48). CONCLUSIONS: The QFT-GIT alone was more effective to detect LTBI than TST alone and had an 81% added value as an add-on sequential test in this population with mild immunosuppression. The cost-effectiveness of these strategies remains to be evaluated.
Assuntos
Síndrome da Imunodeficiência Adquirida/patologia , Tuberculose Latente/diagnóstico , Tuberculose Latente/patologia , Teste Tuberculínico/métodos , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/microbiologia , Adulto , Contagem de Linfócito CD4 , Feminino , Humanos , Testes de Liberação de Interferon-gama , Tuberculose Latente/complicações , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: to evaluate the prevalence of nasal colonization with Staphylococcus aureus in individuals with HIV/AIDS under inpatient treatment in a teaching hospital in the state of São Paulo (Brazil). METHOD: a cross-sectional study undertaken in two units specialized in attending people living with HIV/AIDS, in the period August 2011 - July 2012. Socio-demographic and clinical data was collected through individual interviews and from the medical records; samples of nasal secretion were collected with Stuart swabs on the first day of inpatient treatment. Ethical aspects were respected. RESULT: of the 229 individuals with HIV/AIDS hospitalized in this period, 169 participated in the study, with Staphylococcus aureus being identified in the culture tests of 46 (27.2%) of the individuals, resistance to oxacillin being evidenced in 10 (21.8%) participants. CONCLUSION: the results of the research indicate that the prevalence of colonization with Staphylococcus aureus in individuals with HIV/AIDS in the specialized units was considered relevant, possibly contributing to future investigations and, moreover, to the implementation of measures to prevent and control this pathogen in this population. .
OBJETIVO: avaliar a prevalência da colonização nasal por Staphylococcus aureus em indivíduos com HIV/Aids internados em um hospital-escola do Estado de São Paulo (Brasil). MÉTODO: estudo de corte transversal, realizado em duas unidades especializadas no atendimento a pessoas que vivem com HIV/ Aids, no período de agosto 2011 a julho 2012. Foram coletados dados sociodemográficos e clínicos, por entrevista individual e prontuário; as amostras de secreção nasal foram coletadas por meio de swab Stuart no primeiro dia de internação. Os aspectos éticos foram contemplados. RESULTADOS: dos 229 indivíduos com HIV/Aids internados no período, 169 participaram do estudo, sendo identificado Staphylococcus aureus nos exames de cultura de 46 (27,2%) dos indivíduos, evidenciando-se resistência à oxacilina em 10 (21,8%) participantes. CONCLUSÃO: os resultados da pesquisa apontam que a prevalência da colonização por Staphylococcus aureus em indivíduos com HIV/Aids internados nas unidades especializadas foi considerada relevante, podendo contribuir para novas investigações e, ainda, para implementar medidas de prevenção e de controle desse patógeno nessa população. .
OBJETIVO: evaluar la prevalencia de la colonización nasal por Staphylococcus aureus en individuos con VIH/sida internados en un hospital escuela del Estado de São Paulo (Brasil). MÉTODO: estudio trasversal, desarrollado en dos unidades especializadas en la atención a personas que viven con VIH/ sida, en el período de agosto del 2011 a julio del 2012. Fueron recolectados datos sociodemográficos y clínicos, mediante entrevista individual y archivo; las muestras de secreción nasal fueron recolectadas mediante Swab Stuart en el primer día de internación. Los aspectos éticos fueron contemplados. RESULTADOS: de los 229 individuos con VIH/sida internados en el período, 169 participaron del estudio, siendo identificado Staphylococcus aureus en las pruebas de cultura de 46 (27,2%) de los individuos, evidenciándose resistencia a la oxacilina en 10 (21,8%) participantes. CONCLUSIÓN: los resultados de la investigación indican que la prevalencia de la colonización por Staphylococcus aureus en individuos con VIH/sida internados en las unidades especializadas fue considerada relevante y puede contribuir a otras investigaciones y, además, para implementar medidas de prevención y de control de ese patógeno en esa población. .
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Infecções por HIV/microbiologia , Nariz/microbiologia , Staphylococcus aureus/isolamento & purificação , Síndrome da Imunodeficiência Adquirida/microbiologia , Brasil , Estudos Transversais , Hospitais de Ensino , Infecções EstafilocócicasRESUMO
Introducción: la histoplasmosis constituye la segunda micosis sistémica en orden de frecuencia en Argentina, después de criptococosis, en pacientes HIV positivos. En éstos, la forma clínica diseminada progresiva es marcadora de sida. La coinfección HIV-Histoplasmosis diseminada (HD) en nuestro país ha sido reportada entre 5,3 y 6 %. Métodos: estudio descriptivo, retrospectivo, realizado en un hospital de agudos de CABA, que incluyó pacientes HIV positivos con HD, en el período 2000-2011. Resultados: n:80. Edad, media (desvío estándar, DE): 37 años (8,1). Varones: 81,2%. CD4, mediana (rango intercuartil, RIC): 19,5 cél/µL (7-54). HD como primera marcadora de sida: 70%; serología HIV previa desconocida: 38,7 %. El 11,8% recibía terapia antirretroviral (TARV) al diagnóstico de HD. Otra infección oportunista concomitante al diagnóstico: 29,4%. Clínica 84,7% fiebre, 75% síndrome de impregnación, 72,2% síntomas respiratorios, 56,9% lesiones cutáneo-mucosas, 30,5% hepatosplenomegalia. Laboratorio: 76,2% anemia, 60,3% leucopenia, 42,1% plaquetopenia. Aislamientos: hemocultivos: 81,8%; muestras positivas: piel y mucosas: 39 pacientes, respiratorias: 16 pacientes, médula ósea: 6 pacientes. Radiografía de tórax patológica: 77,6%. Tratamiento: anfotericina B: 58,5%; itraconazol: 91%. Recaída: 21,2%. Mortalidad global: 20,2%, atribuible a HD: 5,9%. Conclusión: HD fue la primera marcadora en el 70% de los pacientes, alrededor de un 40% desconocían su serología y sólo 1 de cada 10 recibía TARV, lo que refleja un retraso en el diagnóstico de HIV en nuestra población. Las principales manifestaciones clínicas semejan otras infecciones oportunistas siendo importante la sospecha diagnóstica para el tratamiento temprano.
Introduction: Histoplasmosis is the second most frequente fungal infection in Argentina, after cryptococcosis in HIV positive patients. In these patients the disseminated clinical presentation is an AIDS-defining condition. Disseminated histoplasmosis (DH) and HIV coinfection has been reported between 5.3 and 6 % in Argentina. Methods: Retrospective, descriptive study, performed in an acute care hospital of Buenos Aires city, including HIV positive patients with DH, between 2000-2011. Results: n: 80. Mean age (standard deviation, SD): 37 years (8.1). Male: 81.2%. Median CD4 (interquartile range, IQR): 19.5 cells/uL (7-54). DH as the first AIDS defining condition: 70%; unknown prior HIV test: 38.7%. ONly 11.8% were receiving antiretroviral treatment at the time of diagnosis of DH. Other concomitant oportunistic infections: 29.4 %. Clinical manifestations: fever 84.7%, constitutinal symptoms 75%, respiratory symptoms 72.2 %, mucocutaneous lesions 56.9%, liver and/or spleen enlargement 30.5%. Laboratory abnormalities: anemia 76.2 %, leucopenia 60.3%, thrombocytopenia 42.1% Microbiological isolates: blood culture 81.8%; others positive samples: 39 of skin and mucosa, 16 of respiratory specimens, 6 of bone marrow. X-ray chest abnormalities: 77.6%. Treatment: amphotericin B: 58.5%; itraconazole: 91%. Relapse: 21.2%. Global mortality: 20.2%, DH atributable mortality: 5.9%. Conclusion: DH was the first AIDS defining condition in 70% of our patients, about 40% were unaware of their serostatus and only one in ten received antiretroviral treatment, reflecting a delay in diagnosis of HIV in our population. The main clinical manifestations resemble other oportunistic infections, so diagnostic of DH should be for considered in order to provide timely treatment.
Assuntos
Humanos , Masculino , Adulto , Adulto Jovem , Anfotericina B/uso terapêutico , Fatores Epidemiológicos , Epidemiologia Descritiva , Histoplasmose/diagnóstico , Infecções Oportunistas/epidemiologia , Itraconazol/uso terapêutico , Estudos Retrospectivos , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/imunologia , Síndrome da Imunodeficiência Adquirida/microbiologiaRESUMO
OBJECTIVE: to evaluate the prevalence of nasal colonization with Staphylococcus aureus in individuals with HIV/AIDS under inpatient treatment in a teaching hospital in the state of São Paulo (Brazil). METHOD: a cross-sectional study undertaken in two units specialized in attending people living with HIV/AIDS, in the period August 2011 - July 2012. Socio-demographic and clinical data was collected through individual interviews and from the medical records; samples of nasal secretion were collected with Stuart swabs on the first day of inpatient treatment. Ethical aspects were respected. RESULT: of the 229 individuals with HIV/AIDS hospitalized in this period, 169 participated in the study, with Staphylococcus aureus being identified in the culture tests of 46 (27.2%) of the individuals, resistance to oxacillin being evidenced in 10 (21.8%) participants. CONCLUSION: the results of the research indicate that the prevalence of colonization with Staphylococcus aureus in individuals with HIV/AIDS in the specialized units was considered relevant, possibly contributing to future investigations and, moreover, to the implementation of measures to prevent and control this pathogen in this population.
Assuntos
Infecções por HIV/microbiologia , Nariz/microbiologia , Staphylococcus aureus/isolamento & purificação , Síndrome da Imunodeficiência Adquirida/microbiologia , Adulto , Brasil , Estudos Transversais , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Estafilocócicas , Adulto JovemRESUMO
Kocuria rosea is an uncommon pathogen may cause opportunistic infections in immunocompromised patient. We report a HIV patient, who presented bacteremia caused by Kocuria rosea. He was successfully treated with vancomycin and by catheter removal.
Assuntos
Síndrome da Imunodeficiência Adquirida/microbiologia , Bacteriemia/imunologia , Hospedeiro Imunocomprometido , Micrococcaceae/classificação , Micrococcaceae/isolamento & purificação , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-IdadeRESUMO
Kocuria rosea is an uncommon pathogen may cause opportunistic infections in immunocompromised patient. We report a HIV patient, who presented bacteremia caused by Kocuria rosea. He was successfully treated with vancomycin and by catheter removal.