Scielo RSS <![CDATA[Brazilian Journal of Infectious Diseases]]> http://www.scielo.br/rss.php?pid=1413-867020100005&lang=en vol. 14 num. 5 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.br/img/en/fbpelogp.gif http://www.scielo.br <![CDATA[<b>Hepatitis C virus</b>: <b>molecular and epidemiological evidence of male-to-female transmission</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500001&lng=en&nrm=iso&tlng=en INTRODUCTION: There is general consensus that hepatitis C virus is efficiently transmitted by the parenteral route, whereas data on viral transmission by sexual or non-sexual intrafamilial contact are conflicting. OBJECTIVE AND METHOD: The aim of this study was to investigate the transmission of hepatitis C virus in nine heterosexual couples. RESULT: The mean age of the couples was 43.7 years. When interviewed, all of the women denied the presence of risk factors for acquisition of the infection, whereas the cause of infection in the nine husbands could be attributed to blood transfusions in two of them (22.2%), use of intravenous and inhaled drugs in six (66.7%), acupuncture in one (11.1%), and tattooing in one (11.1%). All men and none of the women reported sexual relations with sex professionals. The mean homology score (Non Structural 5b-hepatitis C virus) was 98.4%. Among the nine couples with matching subtypes, one (11.1%) was infected with subtype 1a, three (33.3%) with subtype 1b, and five (55.5%) with subtype 3a. Shared personal hygiene items showed a much higher correlation with the possible route of transmission and were better supported by the sequence homology data than the other associated risk factors. Three (33.3%) couples shared toothbrushes, seven (77.8%) shared razor blades, eight (88.8%) shared nail clippers, and six (66.7%) shared manicure cutters. CONCLUSION: Sharing of personal hygiene items was a confounding factor in the discussion of sexual hepatitis C virus transmission and the hypothesis of male-to-female transmission was supported in this study <![CDATA[<b>Prevalence of carbapenem resistant <i>Pseudomonas aeruginosa</i> and <i>Acinetobacter baumannii</i> in high complexity hospital</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500002&lng=en&nrm=iso&tlng=en Pseudomonas aeruginosa and Acinetobacter baumannii are Gram-negative bacilli that in the last decades have become prevalent agents of hospital infection due to high antimicrobial resistance developed by these microorganisms. The present study is a retrospective analysis of all positive cultures for these microorganisms in the period of January 2004 to December 2008. Resistance levels of A. baumannii and P. aeruginosa to carbapenems was high and showed a trend to increase during the period of study. In recent years the increasing incidence and resistance levels of A. baumannii and P. aeruginosa to the antimicrobials used for their treatment in the hospital setting underscores the relevance of infections caused by these bacteria. The selective pressure caused by indiscriminated use of broad-spectrum antibiotics in empirical hospital infections is probably the main reason for such an increase with the consequent impact upon patient morbidity and mortality <![CDATA[<b>Mortality rate in patients with nosocomial <i>Acinetobacter</i> meningitis from a Brazilian hospital</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500003&lng=en&nrm=iso&tlng=en BACKGROUND: The mortality rate due to Acinetobacter baumannii nosocomial meningitis (ANM) is high. OBJECTIVE: The aim of this study was to evaluate the factors that have influence over the outcomes in ANM patients. METHODS: A retrospective analysis of 22 cases of ANM was conducted in a hospital with high incidence of multidrug resistance. RESULTS: The mean age of patients was 43 years (21 to 91) and 54.5% were male. All ANM cases occurred within 60 days of admission and the mean duration of illness was of 18.2 days. All cases were associated with previous neurosurgical procedures: elective surgery (27.2%), external shunt (54.4%) and emergency surgery due to trauma (18.1%). Imipenem resistance was observed in 40.9% of cases, but ampicillin/sulbactam resistance was lower (27.2%). The mortality rate of ANM patients was of 72.7%. The only risk factor associated with mortality was inappropriate therapy within five days after CSF collection. All patients who survived the meningitis episode had received appropriate therapy, in contrast to only 69.2% of those who did not survive (OR = 5.15; IC = 0.45-54.01). CONCLUSIONS: The high mortality rate observed in our study suggests the need for aggressive empirical treatment with addition of drugs, including intrathecal therapy, where multi-resistant A. baumannii is endemic <![CDATA[<b>Candidemia epidemiology and susceptibility profile in the largest Brazilian teaching hospital complex</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500004&lng=en&nrm=iso&tlng=en INTRODUCTION: Although the spectrum of fungi causing bloodstream fungal infections continues to expand, Candida spp. remains responsible for the majority of these cases. OBJECTIVE: The purpose of this study was to characterize the candidemia epidemiology, species distribution and antifungal susceptibility patterns at a Brazilian tertiary teaching public hospital with 2,500 beds. METHODS: Records from the microbiology laboratory were used to identify patients with positive blood cultures during 2006. The in vitro activity of amphotericin B, caspofungin, itraconazole, fluconazole, voricanozole, and posaconazole were determined using the Etest method. RESULTS: One hundred and thirty-six cases of candidemia were identified and 100 strains were available for antifungal susceptibility testing. The overall incidence of candidemia was 1.87 cases/1.000 admissions and 0.27 cases/1.000 patient-days. Among the patients, 58.1% were male, and the median age was 40 years old. C. albicans was the most common species (52.2%), followed by C. parapsilosis (22.1%), C. tropicalis (14.8%), and C. glabrata (6.6%). All strains were susceptible to amphotericin B with a MIC90 of 0.5 µg/mL. Overall susceptibility for voriconozole, fluconazole, and caspofungin was > 97% with a MIC90 of 0.064, 4.0 and 1.0 µg/mL, respectively. For itraconazole the susceptibility rate was 81% with a MIC90 of 0.5 µg/mL. Posaconazole also demonstrated good in vitro activity with a MIC90 of 0.25 µg/mL. CONCLUSION: This is the first antifungal susceptibility report in our institution <![CDATA[<b>DMFT index and oral mucosal lesions associated with HIV infection</b>: <b>cross-sectional study in Porto Velho, Amazonian region - Brazil</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500005&lng=en&nrm=iso&tlng=en We evaluated the DMFT (decayed, missing and filled teeth) index and the prevalence of candidiasis, linear gingival erythema, oral hairy leukoplakia, herpes simplex, aphthous ulcers, Kaposi's sarcoma and lymphoma, as well as the association with TCD4 count, viral load (VL) and antiretroviral therapy (ART) in 140 HIV-infected adult individuals. A standardized examination to determine the DMFT index and the presence of oral lesions was conducted. Demographic data, TCD4 count and use of ART were obtained from medical records. A high number of decayed teeth detected among patients undergoing ART resulted in a mean DMFT of 16.9 teeth. It was observed that 24.2% of the individuals had at least one oral lesion. Candidiasis was the most frequent lesion and was associated with the TCD4 count. Oral hairy leukoplakia was associated with an increased VL. Regular use of ART was inversely associated with the occurrence of lesions. Overall, the studied population showed low prevalence of oral lesions and high DMFT index. The use of ART seems to reduce the occurrence of these lesions. Higher TCD4 count and a lower VL were associated with an improved oral health status in HIV + individuals <![CDATA[<b>Effect of sustained virologic response on the incidence of hepatocellular carcinoma in patients with HCV cirrhosis</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500006&lng=en&nrm=iso&tlng=en BACKGROUND AND OBJECTIVES: Evidence suggests that sustained virologic response to interferon treatment decreases incidence of hepatocellular carcinoma in patients with hepatitis C virus cirrhosis. This study was designed to compare the incidence of hepatocellular carcinoma among cirrhotic patients exposed to interferon based treatment with or without achieving a sustained virological response, in order to evaluate the role of interferon itself in the prevention hepatocellular carcinoma. METHODS: A cohort of 85 patients with compensated hepatitis C cirrhosis was followed after treatment with interferon and ribavirin. Sustained virological response was defined as negative polymerase chain reaction assay 24 weeks after the end of treatment. Patients were followed every 6 months with ultrasound and alpha-fetoprotein. Hepatocellular carcinoma was diagnosed by the finding of a focal liver lesion greater than 2 cm with arterial hypervascularization on two imaging techniques and/or by liver biopsy. RESULTS: The mean follow-up time was 32.1 ± 20 months for patients who achieved a sustained virological response and 28.2 ± 18 months among 47 patients (55%) without SVR. Hepatocellular carcinoma was diagnosed in 1 (3%) vs. 8 (17%) responders and non responders respectively (p = 0.02). CONCLUSION: Patients with cirrhosis due to hepatitis C virus who achieved sustained virological response had significantly lower incidence of hepatocellular carcinoma when compared to those without treatment response. Interferon treatment without achieving sustained virological response does not seem to protect against hepatocellular carcinoma <![CDATA[<b>Molecular typing and biological characteristics of <i>Pseudomonas aeruginosa</i> isolated from cystic fibrosis patients in Brazil</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500007&lng=en&nrm=iso&tlng=en The present study had as objective to evaluate the genotypic diversity and biological characteristics, such as hemolysin, protease, elastase of 56 clinical strains of Pseudomonas aeruginosa isolated from 13 cystic fibrosis (CF) patients attending at the School Hospital of Campinas State University (UNICAMP), Brazil. Genotypic diversity has been determined by Ribotyping (RT) and the pattern of the enterobacterial repetitive intergenic consensus PCR (ERIC-PCR) of each strain. The production of elastase was significantly different only among mucoid and nonmucoid isolates. Joint results obtained by (RT) and ERIC-PCR methods were able to discriminate all strains isolated from both the same and different patients. Additionally, we observed four strain clusters with low diversity. The most infective strains were located in just two clusters. These results suggest that either there is a strong selection towards a specific genotype or that specific isolates could be responsible for the initial and subsequent colonization processes. More studies are necessary to know if these conclusions can be generalized for the general CF population <![CDATA[<b>HLA-Bw4-B*57 and Cw*18 alleles are associated with plasma viral load modulation in HIV-1 infected individuals in Salvador, Brazil</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500008&lng=en&nrm=iso&tlng=en Host genetic factors play an important role in mediating resistance to HIV-1 infection and may modify the course of infection. HLA-B alleles (Bw4 epitope; B*27 and B*57) as well as killer cell immunoglobulin-like receptors have been associated with slow progression of HIV-1 infection. OBJECTIVE: To evaluate the association between serological epitopes HLA-Bw4 and HLA-Bw6 and prognostic markers in AIDS. METHODS: 147 HIV-infected individuals in Bahia, Northeast Brazil, were genotyped for HLA class I locus. HLA class I genotyping was performed by hybridization with sequence-specific oligonucleotide probes following amplification of the corresponding HLA-A, HLA-B and HLA-C genes. Statistical analysis was performed using Fisher's exact and ANOVA tests for categorical and continuous variables, respectively. RESULTS: We detected a significant association (χ2 = 4.856; p = 0.018) between the presence of HLA-Bw4 and low levels of viremia. Eighteen out of the 147 HIV-infected individuals presented viremia <1,800 copies/mL and 129 presented viremia &gt; 2,000 copies/mL. Ninety and four percent (17/18) of all individuals with viremia < 1,800 copies/mL carried HLA-Bw4, compared to 67.4% (87/129) of individuals with viremia &gt; 2,000 copies/mL. Additionally, we found a significantly higher frequency of B*57 (OR = 13.94; 95% CI = 4.19-46.38; p < 0.0001) and Cw*18 (OR = 16.15; 95% CI = 3.46-75.43; p < 0.0001) alleles, favoring the group with lower viremia levels, in comparison with those with higher viral load. CONCLUSION: HLA-Bw4-B*57 and Cw*18 alleles are associated with lower level of viral load in HIV-infected Brazilian patients. These findings may help us in understanding the determinants of HIV evolution in Brazilian patients, as well as in providing important information on immune response correlates of protection for such population <![CDATA[<b><i>In vitro</i></b><b> initial immune response against <i>Leishmania amazonensis</i> infection is characterized by an increased production of IL-10 and IL-13</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500009&lng=en&nrm=iso&tlng=en The initial encounter of Leishmania with its host's immune system is important in the outcome of infection. Previous studies have shown that PBMCs from healthy volunteers (HV) exposed to Leishmania differ in IFN-γ production. We have expanded such observations evaluating the profile and kinetics of cytokines (IFN-γ, IL-12p70, IL-10, IL-13), chemokines (CCL5, CCL3, CCL4, CXCL10), and chemokine receptors (CCR1,CCR5, CXCR3, CCR4) in vitro L. amazonensis-stimulated of HV's PBMCs. HVs were divided in groups of high (HR) or low (LR) IFN-γ responders. In both groups, HR and LR, after L. amazonensis infection there was a predominance of IL-10 and IL-13 over IFN-γ production, while IL-12 was produced in similar amount. Regarding chemokines, a more striking difference was observed for CCL3 expression that was lower at 12 hours and 48 hours post infection in LR than in HR. Interestingly, a downregulation of CCR5 and a greater expression of CCR4 were found in low IFN-γ responders. These data suggest that early after L. amazonensis infection there is a cytokine milieu dominated by IL-13 and IL-10, and despite of this environment, IFN-γ is produced, supporting the complexity of the response. It is noteworthy that the pattern of immune response is mounted in first hours after Leishmania stimulation, with the definition of the differentiation of Th1 versus Th2 cells. It remains to be determined if such an in vitro difference has an in vivo counterpart in terms of susceptibility to infection <![CDATA[<b>High prevalence of hepatitis C associated with familial history of hepatitis in a small town of south Brazil</b>: <b>efficiency of the rapid test for epidemiological survey</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500010&lng=en&nrm=iso&tlng=en This report describes a cross-sectional survey on the prevalence of hepatitis C antibodies (anti-HCV) in Tamboara, a small community in the northwest area from Paraná State, south of Brazil with a high rate of accumulated detection for HCV. Eight hundred and sixteen residents (17.87% from all the population), independently of the age and time living in Tamboara were included in this study by an epidemiologic questionnaire and by testing for anti-HCV. The rapid immuno-chromatographic test was applied for detection of HCV antibodies. The anti-HCV prevalence by rapid test was 4.28%. The median age for positive and negative test was 60.49 ± 14.14 and 41.67 ± 20.25, respectively (p < 0.001). By multivariate analysis, only familial history of hepatitis (p = 0.001; OR = 6.41; CI 95% = 2.08-19.78) and age (p = 0.007; OR 1.06;95% CI = 1.02-1.10) showed statistical significance for positive anti-HCV. The rapid test sensitivity and specificity were 100% and 92.7% respectively, with an accuracy of 95.8% (95% CI = 91-100). These findings demonstrated a high prevalence of anti-HCV in Tamboara. The familial history of hepatitis was a significant risk factor to the infection and HCV rapid test showed to be accurate and feasible for epidemiological survey <![CDATA[<b>HIV-1 resistance testing influences treatment decision-making</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500011&lng=en&nrm=iso&tlng=en OBJECTIVE: To investigates how the use of HIV-1 resistance tests influences physician decision-making. METHODS: Ten experienced reference physicians from the Brazilian Network for Drug Resistance each received ten patients' case histories. The selected patients had experienced at least two virological failures. First, reference physicians were asked to empirically select a new regimen for each patient. Second, after genotype report (ViroSeq 2.6) was provided, and physicians were again asked to select a new regimen considering this additional information. Finally, they were asked to select a regimen after receiving a virtual phenotype result (vircoTYPE 3.9.00). RESULTS: In 79% of the cases, physicians changed their empirical choice of regimen after receiving the genotype report, resulting in an increase in the mean number of active drugs from 1.8 to 2.2 (p = 0.0003), while the average number of drugs/regimen remained at 4.0. After receipt of the virtual phenotype report, additional changes were made in 75% of the patient cases, resulting in an increase in the number of active drugs to 2.8 (p < 0.0001), while the average number of drugs/regimen remained at 4.0. After receipt of the genotype report, 48% of the changes were in NRTIs, 29% were in NNRTIs and 60% were in PIs; after consideration of the virtual phenotype, 61%, 10% and 49% of the changes, respectively, were in these categories of drugs. Fourteen percent of the physicians rated the genotype report as "extremely useful", whereas 34% rated the subsequent virtual phenotype report as "extremely useful" (p = 0.0003). CONCLUSIONS: Resistance testing has a significant impact on physicians' choices of antiretroviral salvage therapies, and it promotes the selection of more active drugs <![CDATA[<b>HIV subtype, epidemiological and mutational correlations in patients from Paraná, Brazil</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500012&lng=en&nrm=iso&tlng=en OBJECTIVE: Analyze patients with HIV infection from Curitiba, Paraná, their epidemiological characteristics and HIV RAM. METHODS: Patients regularly followed in an ID Clinic had their medical data evaluated and cases of virological failure were analyzed with genotypic report. RESULTS: Patients with complete medical charts were selected (n = 191). Demographic and clinical characteristics were compared. One hundred thirty two patients presented with subtype B infection (69.1%), 41 subtype C (21.5%), 10 subtype F (5.2%), 7 BF (3.7%) and 1 CF (0.5%). Patients with subtype B infection had been diagnosed earlier than patients with subtype non-B. Also, subtype B infection was more frequent in men who have sex with men, while non-B subtypes occurred more frequently in heterosexuals and women. Patients with previous history of three classes of ARVs (n = 161) intake were selected to evaluate resistance. For RT inhibitors, 41L and 210W were more frequently observed in subtype B than in non-B strains. No differences between subtypes and mutations were observed to NNTRIs. Mutations at 10, 32 and 63 position of protease were more observed in subtype B viruses than non-B, while positions 20 and 36 of showed more amino acid substitutions in subtype non-B viruses. Patients with history of NFV intake were evaluated to resistance pathway. The 90M pathway was more frequent in subtypes B and non-B. Mutations previously reported as common in non-B viruses, such as 65R and 106M, were uncommon in our study. Mutations 63P and 36I, previously reported as common in HIV-1 subtypes B and C from Brazil, respectively, were common. CONCLUSION: There is a significant frequency of HIV-1 non-B infections in Paraná state, with isolates classified as subtypes C, F, BF and BC. Patients with subtype C infection were more frequently female, heterosexual and had a longer average time of HIV diagnosis <![CDATA[<b>Survey of hepatitis B and C infection control</b>: <b>procedures at manicure and pedicure facilities in São Paulo, Brazil</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500013&lng=en&nrm=iso&tlng=en Bleeding due to the habit of removing the cuticles of the finger and toes nails, without appropriate sterilization of instruments can be an important factor of contamination by hepatitis B and C viruses. The objectives of this study were to verify the use of standards on biosafety in the routine work of manicurists and/or pedicurists located in São Paulo, Brazil; know the level of information they have about ways of transmission and prevention of hepatitis B and C; evaluate the degree of risk perception for accidental exposure to infectious agents; and to estimate the prevalence of serological markers of hepatitis B and C among them. This was descriptive, cross-sectional study that included a random sample of 100 manicurists and/or pedicurists working in beauty salons. We administered a questionnaire to obtain personal information about the characteristics of the participants, collected blood for hepatitis B and C serology and assessed the working environment. Adherence to the professional standards on biosafety has been inadequate, and we noted that only 5% used disposable gloves, none washed their hands, 93% did not previously cleaned their working material and only 7% used disposable materials. A low level of knowledge about the routes of transmission, prevention, standards of biosafety, and risk perception of the infectious agents in their professional activity was observed. One out of ten interviewed manicurist and/or pedicurist had serological markers of hepatitis B or C, with 8% of hepatitis B and 2% of hepatitis C <![CDATA[<b>Carbapenem-resistant <i>Pseudomonas aeruginosa</i></b>: <b>clonal spread in southern Brazil and in the state of Goiás</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500014&lng=en&nrm=iso&tlng=en This study evaluated the clonal spread of carbapenem-resistant P. aeruginosa producing SPM-1 type metallo-β-lactamase (MBL), at the university hospital of Florianópolis, Santa Catarina, Brazil, compared to an epidemic clone previously reported, as well as strains collected in other three Brazilian states. Among the isolates, 17 (62%) were clonal and highly related to strains from other regions of Brazil. Six clonal strains harbored the blaSPM-1 gene. The finding of a unique SPM-1 producer clone suggests that its dissemination has contributed to the high resistance to carbapenems in Brazilian hospitals <![CDATA[<b>HLA-B*5701 frequency in Chilean HIV-infected patients and in general population</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500015&lng=en&nrm=iso&tlng=en It has been demonstrated that HLA-B*5701 screening reduces the risk for hypersensitivity reaction to abacavir in HIV-infected patients. Since B*5701 prevalence varies among different populations, it is important to determine the carrier frequency prior to its use for the screening of HIV-infected patients.The aim of this study was to determine HLA-B*5701 carrier frequency in Chilean general population and HIV-infected patients referred for B*5701 typing. For that purpose 300 blood bank donors and 492 abacavir-naïve HIV-infected patients from Chile were screened for B*5701 by a sequence specific primer PCR.We detected 14/300 (4.7%) B*57-positive individuals in the Chilean general population, 11 (3.7%) were B*5701 positive, and 3 (1%) had another subtype.All were heterozygous,thus a B*5701 allele frequency of 2% was determined.Eleven of 492 (2.2 %) HIV-patients carried a B*5701 allele. The difference between these frequencies is probably due to slow progression of HIV infection in HLA-B*5701 carriers, thus less patients would require antiretroviral therapy and B*5701 typing. Considering the usefulness of B*5701 screening, its prevalence in the Chilean general population,and the availability of a validated method,we conclude that HLA-B*5701 typing in Chilean HIV-infected patients about to initiate abacavir treatment is strongly recommended <![CDATA[<b>Resistance to inhibitors of the human immunodeficiency virus type 1 integration</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500016&lng=en&nrm=iso&tlng=en This review will summarize the role of integrase in HIV-1 infection, the mechanism of integrase inhibitors and resistance with an emphasis on raltegravir (RAL), the first integrase inhibitor licensed to treat HIV-1 infection <![CDATA[<b>Response predictors to treatment with pegylated interferon in chronic hepatitis B</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500017&lng=en&nrm=iso&tlng=en The clinical and epidemiological importance of chronic B hepatitis is currently unquestionable as a cause of end-stage liver disease and hepatocellular carcinoma. Recently, predictors of treatment response of this disease have been studied, both before and during the course of medication. Therapy stopping rules have been proposed, which may be useful in patients presenting poor treatment tolerance. This review discusses the treatment response predictors usefulness, with emphasis on ALT, quantitative HBsAg and HBeAg, quantitative HBV-DNA and HBV genotype <![CDATA[<b>Health surveillance, biosafety and emergence and re-emergence of infectious diseases in Brazil</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500018&lng=en&nrm=iso&tlng=en The present paper presents compulsory notification data for infectious diseases and epidemiologic ones recorded at the Center for Strategic Information and Health Surveillance (CIEVS) for the period of March 2006 to April 2007. Data is presented in accordance with geographic distribution, time and risk classification of the etiologic agents found, according to Ministry of Health regulations. The importance of this epidemiologic surveillance system is presented, debating the main topics required for quality improvement and information analysis. It is concluded, from the analysis of epidemiologic events and their relation to risk management, that the compulsory notification system in Brazil is incomplete, irregular, delayed and, in a large percentage of cases, notification cannot be completed and the agent may not be identified. Quality of data varies from one region to another and from county to county within the same region. There is a high proportion of cases in which the etiologic agent is unknown and, in such cases, a high lethality is expected, establishing a high risk exposure condition for those health professionals involved in health surveillance. From these data, the study points out the need to improve the surveillance system and strengthens the idea of building maximum containment laboratories <![CDATA[<b>Fatal <i>Strongyloides stercoralis</i> hyper-infection in a patient with multiple myeloma</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500019&lng=en&nrm=iso&tlng=en Strongyloides stercoralis (S.S.) is a human intestinal parasite, which may lead to complicated strongyloidiasis. We report a case of disseminated strongyloidiasis following the treatment of myeloma. The patient developed skin lesions, respiratory distress, aseptic meningitis and bacterial and fungal sepsis. The diagnosis of strongyloidiasis was established through endotracheal tube secretions. Despite the treatment with Ivermectin and Albendazole, the outcome was fatal. The value of screening for strongyloidiasis is unclear but may be of benefit in patients with hematological malignancies from high endemic areas <![CDATA[<b>Protein-losing enteropathy in paracoccidioidomycosis identified by scintigraphy</b>: <b>report of three cases</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500020&lng=en&nrm=iso&tlng=en Paracoccidioidomycosis (PCM) or South American Blastomycosis is a systemic fungal infection caused by a dimorphic fungus, Paracoccidioides brasiliensis. It represents the most important systemic mycosis in South America and with higher prevalence among male inhabitants of the rural area. PCM usually affects the lungs, and rarely the intestines. The authors report three cases of PCM, treated at the University Hospital of Universidade Federal de Mato Grosso do Sul whose scintigraphy with technetium-99 labeled human albumin revead intestinal protein loss <![CDATA[<b>First report of submandibular and parotid abscess due to <i>Nocardia asteroides</i></b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500021&lng=en&nrm=iso&tlng=en Paracoccidioidomycosis (PCM) or South American Blastomycosis is a systemic fungal infection caused by a dimorphic fungus, Paracoccidioides brasiliensis. It represents the most important systemic mycosis in South America and with higher prevalence among male inhabitants of the rural area. PCM usually affects the lungs, and rarely the intestines. The authors report three cases of PCM, treated at the University Hospital of Universidade Federal de Mato Grosso do Sul whose scintigraphy with technetium-99 labeled human albumin revead intestinal protein loss <![CDATA[<b>Primary onychomycosis with granulomatous <i>Tinea faciei</i></b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702010000500022&lng=en&nrm=iso&tlng=en Paracoccidioidomycosis (PCM) or South American Blastomycosis is a systemic fungal infection caused by a dimorphic fungus, Paracoccidioides brasiliensis. It represents the most important systemic mycosis in South America and with higher prevalence among male inhabitants of the rural area. PCM usually affects the lungs, and rarely the intestines. The authors report three cases of PCM, treated at the University Hospital of Universidade Federal de Mato Grosso do Sul whose scintigraphy with technetium-99 labeled human albumin revead intestinal protein loss