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Brazilian Journal of Infectious Diseases, Volume: 11, Número: 1, Publicado: 2007
  • Immunological synapses in infectious diseases Letter To The Editor

    Siqueira-Batista, Rodrigo; Geller, Mauro; Gomes, Andréia Patrícia
  • I Consensus for the Management and Treatment of Hepatitis B Carried Out by the Brazilian Society of Infectious Diseases Brief Communications

  • Causes of hospitalization among extra-European Union children in a large hospital of Northern Italy, in a five-year observation period Brief Communications

    Sabbatani, Sergio; Baldi, Elena; Manfredi, Roberto

    Resumo em Inglês:

    The hospitalizations of 1,239 patients aged 14 years or less and immigrated from extra-European Union countries in Italy were assessed in the 6-year period, from 1999 to 2004. The main demographic and clinical features were analyzed according to several variables, also distiguishing patients aged less than one year, from those aged 1-14 years. The introduction of a deed of indemnity law in 2001 profoundly changed the pattern of admissions and health care needs and exploitation during subsequent years, leading to a massive regularization of clandestine immigrants.
  • Latent human herpesvirus - 8 (HHV-8) infection in female commercial sex workers from Imbituba, Santa Catarina, Brazil Brief Communications

    Caterino-de-Araujo, Adele; Santos-Fortuna, Elizabeth; Magri, Mariana Cavalheiro; Schuelter-Trevisol, Fabiana; Silva, Marcos Vinicius

    Resumo em Inglês:

    Human herpesvirus 8 (HHV-8) infection was identified in 6 out of 90 (6.7%) female commercial sex workers from Imbituba, Santa Catarina, and was associated to age. Frequencies of 5.6% of anti-latent and 3.3% of anti-lytic antibodies were detected. Considering non-endemic areas from Brazil, the anti-latent antibodies frequency seems elevated and requires further investigation on referent female population.
  • Hepatitis C risk factor for patients submitted to dialysis Original Papers

    Baldessar, Maria Zélia; Bettiol, Jane; Foppa, Fabrício; Oliveira, Lúcia Helena das Chagas

    Resumo em Inglês:

    This article reports the results of the research which has evaluated the prevalence and factors associated to the presence of Hepatitis C in patients submitted to dialysis at the Clinica de Doenças Renais (Clinic of Renal Diseases) in Tubarao city (CRDT), Santa Catarina State, Brazil, in the period between January 1st, 2004 to December 31st in the same year. The prevalence of 16.8% of Hepatitis C in the studied population and the time-length of dialysis as significative risk factor have become evident. The non-correlation of seropositivity of the followings factors is also indicated: age, gender, base diseases, infrastructures, the type of clinic machines, the type of dialyser, used membranes, the machine sterilisation and substances for this process as well as the number of times of the dialyser reutilization. The data represented in this project suggest that the Hepatitis C presents high prevalence in patients in dialysis and the time-length of the treatment is a risky factor to acquire the infection.
  • Factors associated with clinical, immunological and virological responses in protease-inhibitor-experienced brazilian children receiving highly active antiretroviral therapy containing Lopinavir-Ritonavir Original Papers

    Machado, Daisy Maria; Gouvêa, Aída de Fátima Barbosa; Cardoso, Maria Regina; Beltrão, Suênia Vasconcelos; Cunegundes, Kelly Simone; Bononi, Fabiana; Almeida, Fernanda; Cavalheiro, Kaline; Angelis, Daniela Souza Araújo de; Succi, Regina Célia de Menezes

    Resumo em Inglês:

    This study evaluates clinical, virological and immunological responses to antiretroviral (ARV) therapy based on Lopinavir/ritonovir (LPV/r) in previously protease -inhibitor-experienced children. The study included 29 Brazilian children (median age = 5.91 years) who had failed previous ARV therapy and had begun a regimen based on LPV/r. At 12 months follow-up, a good virological response to LPV/r therapy was defined as achieving an undetectable viral load or as a decrease in plasma HIV RNA levels to > 1 log. A good immunological response was defined as an increase in CD4+ cell count from baseline sufficient to attain a better CDC immune stage classification. The number of infectious episodes 12 months before and 12 months after beginning LPV/r was assessed. Sixteen (55.2%) and 19 (65.5%) of 29 patients exhibited good virological and immunological responses, respectively. Baseline CD4+ values (>500) predicted both virological and immunological responses (p<0.05). Older children were less likely to develop an immunological response (p<0.001) than younger children. Nine children receiving 3 ARV drugs plus LPV/r showed an immunological response (100%) compared to 10/20 (50%) children receiving 2 drugs plus LPV/r (p=0.01). A lower number (n<5) of infectious episodes was noted after 12 months follow-up in children using the LPV/r regimen (p=0.006). There was a positive correlation between children whose baseline CD4+ values were greater than 500 cells/mm³ and virological responses. Although virological responses to therapy were seen in about half the children (55.2%), the use of HAART containing LPV/r provided clinical and immmunological benefits.
  • Self-reported adverse reactions among patients initiating antiretroviral therapy in Brazil Original Papers

    Pádua, Cristiane A. Menezes de; César, Cibele C.; Bonolo, Palmira F.; Acurcio, Francisco A.; Guimarães, Mark Drew C.

    Resumo em Inglês:

    A cross-sectional analysis was carried out to describe adverse reactions to antiretroviral therapy (ART) reported by HIV-infected patients initiating treatment at two public health AIDS referral centers in Belo Horizonte, Brazil, 2001-2003 and to verify their association with selected variables. Adverse reactions were obtained through interview at the first follow-up visit (first month) after the antiretroviral prescription. Socio-demographic and behavioral variables related to ART were obtained from baseline and follow-up interviews and clinical variables from medical charts. Patients with four or more reactions were compared to those with less than four. Odds ratio with 95% confidence interval were estimated using logistic regression model for both univariate and multivariate analyses. At least one adverse reaction was reported by 92.2% of the participants while 56.2% reported four or more different reactions. Antiretroviral regimens including indinavir/ritonavir, irregular use of antiretrovirals and switch in regimens were independently associated with four or more adverse reactions (OR=7.92, 5.73 and 2.03, respectively). The initial period of ARV treatment is crucial and patients´ perception of adverse reactions should be carefully taken into account. Strategies for monitoring and management of adverse reactions including the choice of regimens and the prevention of irregular ART should be developed in AIDS/HIV referral centers in Brazil to promote better adherence to antiretroviral therapy.
  • Identification and characterization of previously described epitopes in HIV-1 subtypes B, C, F and BF in Brazil Original Papers

    Queiroz, Artur Trancoso Lopo de; Santos, Luciane Amorim; Moreau, Domingos Ramon; Oliveira, Tulio de; Watkins, David I.; Galvão-Castro, Bernardo; Alcantara, Luiz Carlos Junior

    Resumo em Inglês:

    Genetic analysis of HIV-1 is essential to improve treatment strategies and select epitopes for vaccine programs. The objective of this study was to determine whether known CD4+ and CD8+ epitopes were present in Brazilian HIV-1 strains. We used previously described CD8+ and CD4+ epitopes from the Los Alamos laboratory to search for these epitopes in the Brazilian sequences using the HIVbase program and we compared the frequency results with the analyses using physical-chemical profile tools from Network Protein Sequence Analysis (NPSA), and the SYFPEITHI program. Furthermore, this analysis was carried out with the Prosite tool using the GeneDoc program and ds/dn analyses using the Synonymous Nonsynonymous Analysis Program (SNAP). The HIVbase epitope mapping demonstrated that 30 CD8+ and 6 CD4+ epitopes were present in the Brazilian sequences at a high frequency. Only two of these epitopes were heavily glycosylated. Interestingly, ds/dn analyses showed evidence of purifying selective pressure. These types of analyses could be useful for the assessment of possible vaccine efficiency in populations.
  • Avascular necrosis of the femoral head in HIV infected patients Original Papers

    Matos, Marcos Almeida; Alencar, Rafael Watt de; Matos, Simone Souza da Rocha

    Resumo em Inglês:

    Avascular necrosis (AVN) of the femoral head is an emerging complication in HIV infected patients. It has been suggested that the increased incidence of AVN in this population may be caused by an increased prevalence of predisposing factors for osteonecrosis, including protease inhibitors, hyperlipidemia, corticosteroid use, alcohol and intravenous drug abuse. The aim of this study was to assess the risk factors for avascular necrosis developing in the femoral head of HIV infected individuals. This study consisted of meta-analysis of the secondary data extracted from current literature. The selected articles allowed two study groups to be drawn up for comparison. Group 1 comprised 324 individuals infected by the HIV virus, who did not present femoral head AVN. Group 2 comprised 32 HIV positive patients, who presented femoral head AVN. The parameters used for analysis were as follows: age, gender, sexual preference, use of intravenous drugs, time of diagnosis, CD4+ cell count, use of antiretroviral agents and duration, serum cholesterol and serum triglycerides. The present study found a statistically significant association between hypertriglyceridemia, hypercholesterolemia, sexual preference and intravenous drug abuse. The authors concluded that femoral head osteonecrosis is associated with hyperlipidemia (hypercholesterolemia and hypertriglyceridemia) and intravenous drug abuse. This study supports the hypothesis that protease inhibitors play a role in the development of osteonecrosis through a tendency to cause hyperlipidemia.
  • Molecular characterization of group A rotavirus isolates obtained from hospitalized children in Salvador, Bahia, Brazil Original Papers

    Serravalle, Karina; Santos, Norma; Sardi, Silvia Inês; Silva, Sarah Peregrino Santos; Ribeiro Junior, Hugo da Costa; Mattos, Ângela Peixoto de; Campos, Gúbio Soares

    Resumo em Inglês:

    Rotavirus is a major cause of infectious diarrhea in infants and young children. The objective of this study was to characterize the genotypes of Human Rotavirus found in children hospitalized with acute diarrhea in the Pediatric Hospital Prof. Hosannah de Oliveira of the UFBA in Salvador, Bahia, Brazil, during the years of 1999, 2000 and 2002. Fecal samples were analyzed (n=358) by methods EIARA and SDS-PAGE for detection of Rotavirus. Positive samples of one or two of these methods (n=168) were submitted to RT-PCR and Multiplex-Nested PCR to determine genotypes G and P. A hundred sixty-eight (46.9%) samples were positive and 190 (53.1%) negative. Only 17 (4.7%) samples had divergent results. The distribution of genotypes G during the first year, showed that the genotype G9 was present in 96,8% of the analyzed samples, in the second year, it was responsible for 96% and in the third year, 88,1%. The characterization of genotypes P demonstrated that the genotype P1A[8] was the most outstanding in all years. In this study we discuss the benefit to control the genotypes of Rotavirus through the molecular characterization for the development of potential vaccines.
  • Evaluation of the Susceptibility profiles, genetic similarity and presence of qnr gene in Escherichia coli resistant to ciprofloxacin isolated in Brazilian hospitals Original Papers

    Pereira, Andrea S.; Andrade, Soraya S.; Monteiro, Jussimara; Sader, Helio S.; Pignatari, Antonio C.C.; Gales, Ana C.

    Resumo em Inglês:

    Increasing quinolone resistance has been reported worldwide, mainly among clinical isolates of Escherichia coli. The objectives of this study were to determine the susceptibility profile, the genetic relatedness, and the prevalence of the qnr gene among ciprofloxacin-resistant Escherichia coli isolated from distinct Brazilian hospitals. A total of 144 ciprofloxacin-resistant Escherichia coli were isolated from 17 Brazilian hospitals between January/2002 and June/2003. The antimicrobial susceptibility testing was performed by microdilution according to NCCLS. The presence of the qnr gene was initially screened by colony blotting, and then confirmed by PCR followed by DNA sequencing. Ninety-five urinary ciprofloxacin-resistant Escherichia coli were further selected for molecular typing by pulsed-field gel electrophoresis (PFGE). Imipenem and meropenem showed the highest susceptibility rates (100.0% for both compounds) followed by amikacin (91.0%) and piperacillin/tazobactan (84.8%). A single ciprofloxacin-resistant Escherichia coli isolate was positive for qnr among the 144 ciprofloxacin-resistant Escherichia coli. Forty-six PFGE patterns were observed among the 95 ciprofloxacin-resistant Escherichia coli type. This study shows that therapeutic options are limited for treatment of ciprofloxacin-resistant Escherichia coli due to the presence of additional mechanisms of antimicrobial resistance, such as ESBL production. The qnr gene was uncommon among ciprofloxacin-resistant Escherichia coli clinical isolates, but its identification might indicate the emergence of this mechanism of quinolone resistance in Brazil. The great genomic variability found among the ciprofloxacin-resistant Escherichia coli highlights the importance of the appropriate use of quinolone to restrict the selection of resistant isolates.
  • Association of IL-8-inducing strains of diffusely adherent Escherichia coli with sporadic diarrheal patients with less than 5 years of age Original Papers

    Meraz, Ismail Mustafa; Arikawa, Kentaro; Nakamura, Hiromi; Ogasawara, Jun; Hase, Atsushi; Nishikawa, Yoshikazu

    Resumo em Inglês:

    The role of diffusely adherent Escherichia coli (DAEC) in diarrheal disease has been controversial. However, DAEC strains were recently implicated in diarrheal disease in developing countries. To clarify whether DAEC are prevalent among sporadic cases of diarrheal illness in Osaka City, Japan, E. coli strains isolated between July 1997 and March 2000 during diarrheagenic E. coli (DEC) investigation were retrospectively examined. DAEC strains were recognized among 41 (4.4%) of 924 patients and formed the biggest subgroup of DEC. Previously, we reported that some DAEC strains caused epithelial cells to secrete as much IL-8 as enteroaggregative E. coli strains did. In this study, we attempted to evaluate epidemiologically whether the ability of DAEC to induce IL-8 was involved in the pathogenesis. Relationship among patient age, symptoms, Afa adhesins, season and IL-8 induction were examined. The subgroup of DAEC that possessed Afa genes and/or induced a high level of IL-8 was significantly prevalent among patients age 1 to 4 years; however total DAEC was not significantly high among the children compared to other age group. IL-8 inducing DAEC seems to play a role in causing sporadic diarrheal illnesses, particularly in pediatric fields. Investigations highlighting the relationship between IL-8 induction and enteropathogenicity are clearly necessary to confirm the role of DAEC in infectious enteritis.
  • beta-lactamase production Haemophilus spp. and resistance to ampicillin in a general hospital in Porto Alegre city, RS, Brazil (2001-2005) Original Papers

    Ferreira, Jorge A. S.; Castro, Andréa Cauduro de; Rocha, Marion P.; Riboldi, Gustavo; d'Azevedo, Pedro Alves

    Resumo em Inglês:

    In a four-year period (July/2001-June/2005), 410 Haemophilus spp. isolates were studied. Those were isolated from sputum at Hospital Nossa Senhora da Conceição (NSC) in Porto Alegre city (RS). beta-lactamase enzyme was detected in 113 (27.6%) of isolates through chromogenic cephalosporin method. Fifty-eight (51.3%) of them showed sensibility to ampicillin through disc-diffusion method using Haemophilus Test Medium (HTM) by NCCLS criteria. In 297 (72.4%) isolates beta-lactamase was not detected by chromogenic cephalosporin method. Five (1.7%) of them were resistant and 1 (0.3%) intermediate to ampicillin using disc-diffusion method. The authors emphasized the importance of Haemophilus spp. resistance to ampicillin research in clinical laboratories routine and the use of more than one method for this analysis was proposed, due to different resistance mechanisms in Haemophilus spp.
  • Vancomycin use in a hospital with high prevalence of Methicillin-Resistant Staphylococcus aureus: comparison with Hospital Infection Control Practices Advisory Committe Guidelines (HICPAC) Original Papers

    Melo, Daniela Oliveira de; Sasaki, Marli; Grinbaum, Renato Satovschi

    Resumo em Inglês:

    This study evaluates vancomycin prescribing patterns in a tertiary-care hospital, with high prevalence of methicillin-resistant Staphylococcus aureus, comparing with the guidelines proposed by the Hospital Infection Control Practices Advisory Committee. The study was conducted in a 930-bed tertiary-care hospital, during 40 days (March 10 to April 30, 2003). Data were collected of all patients given vancomycin, using a standardized chart-extraction form designed. Inappropriate use was subdivided in five categories: empiric therapy without risk factors; continued empiric use for presumed infections in patients whose cultures were negative for beta-lactam-resistant Gram-positive microorganisms; treatment of infections caused by beta-lactam-sensitive Gram-positive microorganisms, without allergy history to beta-lactam antimicrobials; treatment in response to a single blood culture positive for coagulase-negative staphylococcus, if other blood cultures taken during the same time frame were negative; systemic or local prophylaxis for infection or colonization of indwelling central or peripheral intravascular catheters. Of 132 orders, 126 (95.4%) were considered to have been appropriate. Of these 126 prescriptions, 31 (24.6%) were administered for treatment of proven Gram-positive infections (78.1% of those were MRSA), 1 (0.8%) for beta-lactam allergy and 95 (75.4%) for empiric treatment of suspected Gram-positive infections. The majority of the patients (88.6%) have used antimicrobial recently (3 months). The mean pre-treatment hospitalization period was 14±15 days. Of the 132 treatments, 105 (79.5%) were nosocomial infections. In the institution analyzed, the vancomycin use was considered conscientious. Reduction in use of glycopeptide may be obtained by adaptations the CDC criteria, or by improvement of diagnostic criteria.
  • Efficacy of a program of prevention and control for methicillin-resistant Staphylococcus aureus infections in an intensive-care unit Original Papers

    Moreira, Marina; Freitas, Marise R.; Martins, Sinaida T.; Castelo, Adauto; Medeiros, Eduardo Alexandrino Servolo

    Resumo em Inglês:

    Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in most Brazilian Hospitals, and there are few studies which show the efficacy of control measures in such situations. This study evaluated intensive care unit (ICU) patients, in two years divided in control, intervention and post-intervention group. Intervention measures: hands-on educational programs for healthcare workers; early identification of MRSA infected or colonized patients, labeled with a bed-identification tag for contact isolation; nasal carriers, patients, and healthcare professionals treated with topical mupirocin for five days. The hospital infection rates in the control period were compared to the ones in the post-intervention period. Hospital infection rates were found by means of the NNISS methodology The incidence coefficients of MRSA hospital infection (monthly average of 1,000 pts/day) in the control, intervention and post-intervention groups were respectively: 10.2, 5.1 and 2.5/1,000 pts/day (p<0.001) and MRSA-originated bloodstream infections were 3.6, 0.9 and 1.8/1,000 central venous catheter/day (p=0.281). Nasal colonization in both intervention and post-intervention periods was of 30.9% and 22.1% among the hospitalized patients, respectively 54.4% and 46.1% of whom were already MRSA-positive when admitted to the unit. In the intervention period, most of those MRSA infected patients (76.2%) were nasal carrier. Mortality rates were, respectively 26.6%; 27.3% and 21.0% (p<0.001). Nasal carriers, both patients (93.7%) and healthcare professionals (88.2%), were successfully treated with topical mupirocin. Intervention measures for the prevention and control of MRSA infections in ICUs, have been efficient in the reduction of the bloodstream and MRSA-originated hospital infections incidence, and reduced the overall mortality rate significantly.
  • Associated risk factors and pulsed field gel electrophoresis of nasal isolates of Staphylococcus aureus from medical students in a tertiary hospital in Lagos, Nigeria Original Papers

    Adesida, Solayide A.; Abioye, Olusegun A.; Bamiro, Babajide S.; Brai, Bartholomew I.C.; Smith, Stella I.; Amisu, Kehinde O.; Ehichioya, Deborah U.; Ogunsola, Folasade T.; Coker, Akitoye O.

    Resumo em Inglês:

    Staphylococcus aureus infections are growing problems worldwide with important implications in hospitals. The organism is normally present in the nasal vestibule of about 35% of apparently healthy individuals and its carriage varies between different ethnic and age groups. Staphylococcal nasal carriage among health workers is particularly important to establish new clones and track origin of infections during outbreak situations. To determine the carriage rate and compare the pulsed field gel patterns of the strains, nasal swabs were collected from 185 medical students in a teaching hospital in Lagos, Nigeria. Isolates of S. aureus were tested for heamolysin production, methicillin sensitivity and Pulsed Field Gel Electrophoresis (PFGE) was performed. The results showed S.aureus nasal carrier rate of 14% with significant rate among males compared to females. All the isolates produced heamolysin. Antibiotic susceptibility pattern revealed that majority of the isolates was susceptible. Five strains (19%) harboured resistant determinants to penicillin and tetracycline. None of the strains was resistant to methicillin. 44% of the isolates typed by PFGE had type B, the most predominant pulsotype. PFGE A clone exhibited a single resistance phenotype suggesting a strong clonal relationship that could punctual an outbreak in the hospital. The results speculate that nasal carriage among medical personnel could be a function of various risk factors. Personal hygiene and behaviour may however be the means to reducing colonization and spread of S.aureus in our hospitals.
  • Evaluation of reagent strips for ascitic fluid leukocyte determination: is it a possible alternative for spontaneous bacterial peritonitis rapid diagnosis? Original Papers

    Ribeiro, Tarsila C.R.; Kondo, Mario; Amaral, Ana Cristina C.; Parise, Edson Roberto; Bragagnolo Júnior, Maurício A.; Souza, Aécio Flávio Meirelles de

    Resumo em Inglês:

    In order to evaluate the accuracy of a urine reagent dipstick (Multistix 10SG®) to determine ascitic fluid leukocyte count, we prospectively studied 106 cirrhotic patients from April 2003 to December 2004, in two different centers (Federal University of São Paulo - UNIFESP-EPM and Federal University of Juiz de Fora - HU-UFJF) for the rapid bedside diagnosis of spontaneous bacterial peritonitis. The mean age 54 ± 12 years, there was a predominance of males (eighty-two patients, 77%), and alcohol was the most frequent etiology (43%). Forty-four percent of patients were classified as Child B and fifty-one as Child C (51%). Abdominal paracentesis was performed both in outpatient and inpatient settings and the Multistix 10SG® was tested. Eleven cases of spontaneous bacterial peritonitis were identified by means of polymorphonuclear count. If we considered the positive Multistix 10SG® result of 3 or more, the sensitivity, specificity, positive and negative predictive value were respectively 71%, 99%, 91% and 98%. With a positive reagent strip result taken as grade 2 (traces) or more, sensitivity was 86% and specificity was 96% with positive and negative predictive values of 60% and 99%, respectively. Diagnostic accuracy was 95%. We concluded that the use of a urine reagent dipstick (Multistix 10SG®) could be considered a quick, easy and cheap method for ascitic fluid cellularity determination in SBP diagnosis.
  • Community-acquired pneumonia by Chlamydophila pneumoniae: a clinical and incidence study in Brazil Original Papers

    Chedid, Maria Bernadete; Chedid, Márcio Fernandes; Ilha, Darcy Oliveira; Bozzetti, Mary Clarisse; Chaves, Letícia; Griza, Daniela; Dalcin, Paulo Roth

    Resumo em Inglês:

    As there was not any data on Chlamydia pneumoniae (TWAR) infections in Brazil so far, a prospective cohort study of adult patients hospitalized due to CAP was carried out for one year in a Brazilian university general hospital to detect the incidence of CAP by Chlamydophila pneumoniae (TWAR) for one year. During a whole year 645 consecutive patients hospitalized due to an initial presumptive diagnosis of respiratory diseases by ICD-10 (J00-J99), excluding upper respiratory diseases, were screened; 59 consecutive patients with CAP were diagnosed. They had determinations of serum antibodies to C. pneumoniae by microimmunofluorescence at the Infectious Diseases Laboratory of University of Louisville (KY, USA); 37 patients (63.8%) had seroreactivity to TWAR antigens, from which 23 (39.6%) had previous infection; 3 patients (5.2%) were diagnosed with CAP by TWAR and got cured. The incidence of TWAR CAP in our hospital by seroconversion was 5.2%. Our incidence of 5.2% is probably underestimated since TWAR culture was not available; we suggest that Real-Time PCR be used along with other diagnostic methods in future studies to detect the actual incidence of TWAR CAP. We propose that the serological criterion of IgM >1:16 alone to the diagnosis of acute infection by TWAR are discontinued due a lack of specificity.
  • Predictive model for the diagnosis of tuberculous pleural effusion Original Papers

    Neves, Denise Duprat; Dias, Ricardo Marques; Cunha, Antônio José Ledo A. da

    Resumo em Inglês:

    This study developed a predictive model to identify pleural tuberculosis. A consecutive cases study of patients investigating the cause of pleural effusion, in an area of high prevalence of tuberculosis (Rio de Janeiro, Brazil). Clinical and laboratory variables were compared among patients with tuberculosis (TB) and without tuberculosis (NTB), individually and using logistic regression. The performance was described as diagnostic accuracy, compared to a gold standard in a masked way. We have studied 104 TB patients, 41 with malignant, 29 transudates, 28 parapneumonic, 13 with miscellaneous diseases. After identification of individual discrimination power aided by clinical, radiological and laboratory variables, the following ones were included in a multivariate analysis: ADA, total leukocytes, percentile of lymphocytes, protein, lactate dehydrogenase, duration of disease, age and gender. A logistic regression model to predict pleural tuberculosis including the five first variables showed the best performance. A receiver operating characteristic curve identified the best cutoff at 0.7, resulting in a sensitivity and specificity of more then 95%. The predictive model improved the specificity of ADA alone, keeping its sensitivity. This model seems helpful when a microbiological or histological diagnosis of pleural tuberculosis could not be established. External validation of these results is necessary before recommendation for routine application.
  • Correlation between Helicobacter pylori infection, gastric diseases and life habits among patients treated at a university hospital in Southeast Brazil Original Papers

    Módena, José Luiz Proença; Acrani, Gustavo Olszanski; Micas, André Fernando Ditondo; Castro, Marly de; Silveira, Wanderley Dias da; Módena, José Luiz Pimenta; Oliveira, Ricardo Brandt de; Brocchi, Marcelo

    Resumo em Inglês:

    Helicobacter pylori is considered a significant agent in the development of various gastric diseases. However, the diseases caused by this bacterium are known as being multi-factorial, with the genotype, immune system and life habits of the host playing important roles in the establishment of the clinical outcome. Also, H. pylori exhibit a high degree of genetic variability, contributing to the complexity of the host-pathogen relationship. These observations, considered together with the widely-varying origins and social habits of the Brazilian population, lead us to speculate about the influence of these life habits on H. pylori infection and the clinical outcome. Therefore, in this study we evaluated the relationship between H. pylori infection and certain diseases in 172 patients treated at the Hospital das Clínicas of Ribeirão Preto (HCRP), Brazil, taking into account their different life habits, such as non-steroidal anti-inflammatory drugs and alcohol ingestion, and smoking habit. Our analysis indicated that H. pylori infection is not affected by any of the life habits evaluated but is associated with the development of peptic ulcers (gastric and duodenal ulcer) and inverse correlate with gastroesophageal reflux disease (GERD). No correlation was found between the infection with this bacterium and gastritis or intestinal metaplasia. However, gastritis and erosive gastritis were directly correlated with non-steroidal anti-inflammatory drugs (NSAID) ingestion. Moreover, ingestion of alcohol beverages exhibited a protective effect on gastritis development in men. Our data also indicated that to achieve reliable detection of this bacterium in biopsies, two or three detection methods should be used.
  • Etiology and pathogenesis of bloodstream infections associated with the use of long-term central vascular catheter (CVC) in patients who undergone gastrointestinal surgery Original Papers

    Brito, Cristiane Silveira; Gondim, Bruna Amâncio; Diogo Filho, Augusto; Gontijo Filho, Paulo P.

    Resumo em Inglês:

    CVC is the main factor of risk of bloodstream infections. This study purpose was determining both etiology and pathogenesis of these infections in 80 patients who undergone gastrointestinal surgery and who worn long lasting CVC, in the institution HC-UFU. Cultures were made in nostril, skin of the insertion site, tip and catheter hub, in addition to hemoculture in those suspects of sepsis. The colonization incidence rate of the catheter tip was 12.5/ 1,000 catheter days and the CVC associate infection rate was 3.1/1,000 catheter days. Frequencies of skin, hub and catheter tip colonization were 13.8%, 8.9% and 13.3%, respectively. Coagulase-negative Staphylococci were the most found microorganisms in nostril (74%), skin (45.4%) and hub (75%) and Gram-negative bacilli (50%), followed by S. aureus (25%) the most common ones in catheter tip. Approximately 51% of patients received antibiotics and most of them (53.7%) had therapeutic purpose. The frequency of patients with clinical sepsis was 27.5%. Three cases of bacteremia associated with the use of CVC were detected (3.8%), with S. aureus in two of them and K. pneumoniae in the third one. There was not seen any association of skin and hub colonization with their presence in the catheter tip and in the blood of these patients, but S. aureus was recovered from nostril of those with sepsis by this pathogenic agent. A greater concern is suggested over preventive measures and control of these primary and secondary bloodstream, as well as catheter tip colonization.
  • Antimicrobial resistance of clinical and environmental strains of Vibrio cholerae isolated in Lima-Peru during epidemics of 1991 and 1998 Original Papers

    Ibarra, J.O.; Alvarado, D.E.

    Resumo em Inglês:

    The susceptibility in vitro of 71 isolations of V. cholerae was evaluated: 24 of clinical origin and 47 strains of clinical and environmental origin collected in the epidemic of 1991 and during the outbreak epidemic of 1998 in Lima-Peru respectively. The biochemical and serological tests carried out established that 43 (60,6%) corresponded to the serogroup O1 Ogawa of the 1998 epidemic; 26 (36.6%) were of the serotype Inaba, being 24 of them isolated in 1991. Two strains did not belong to the serogroup O1. By means of disk diffusion method and Minimal Inhibitory Concentration (MIC), 15 strains with multi-resistance to antibiotics were determined, 10 of which were of clinical origin and 5 of natural origin, showing 9 antibiotypes with different resistance pattern. The evaluation of susceptibility in front of the vibriostatic agent O/129, demonstrated that 11.4% of the strains, collected in 1998, presented resistance to a concentration of 150 µg. A direct relationship among the resistance that presented the strains of clinical and environmental origin isolated in 1991 and 1998 was established as much for tetracycline, sulfa/trimethoprim and 0/129; 88.6% of the clinical strains of the year 1998 presented resistance to these three drugs, while 100% of clinical strains isolated in 1991 were sensitive to O/129 (150 µg), sulfa/trimethoprim and tetracycline. We conclude that V. cholerae O1 has increased its resistance to antimicrobial drugs of clinical use in the same way it is also losing susceptibility to the vibriostatic compound O/129 for what their use is not recommended for taxonomic purposes.
  • Comparison of conventional methods for diagnosis of visceral leishmaniasis in children of the Center-West Region of Brazil Original Papers

    Brustoloni, Yvone M.; Cunha, Rivaldo V.; Dorval, Maria Elizabeth; Oshiro, Elisa T.; Pontes, Elenir R.J.C.; Oliveira, Ana Lúcia L.; Hillebrand, Lilian; Ribeiro, Luis Felipe

    Resumo em Inglês:

    In Brazil, sophisticated techniques currently employed for diagnosis of visceral leishmaniasis, such as polymerase chain reaction-based assays, are only available in major research centers, whereas conventional methods are still used in many areas where the disease occurs. In the state of Mato Grosso do Sul, in the country's Center-West Region, visceral leishmaniasis has recently emerged in many cities, and duration of the disease, from the onset of symptoms to diagnosis, has been short. Considering that results of diagnostic tests may depend on the phase of the disease, we compared direct examination of bone marrow aspirates (BMAs), BMA culture, and serology by Indirect Immunofluorescence Antibody Test (IFAT) for diagnosis in children, according to time of evolution (< 30 days or >30 days) and to spleen size (< 5 cm or > 5 cm) at admission. Duration of the illness did not interfere with test positivity: direct smear examination and IFAT were positive in more than 80% of patients, as was culture in around 60%. Results of positive microscopy, however, where predominant in patients with larger spleens. Thanks to the association of traditional techniques, only a few patients had to begin a treatment trial without confirming the diagnosis. Conventional methods for diagnosis of visceral leishmaniasis are still indispensable in our region, and training professionals in basic techniques should be incremented. The highest sensitivity in laboratory diagnosis among the cases investigated was that obtained with a combination of BMA direct examination and IFAT, nearing 100%.
  • Angioinvasive pulmonary aspergillosis after allogeneic bone marrow transplantation: clinical and high-resolution computed tomography findings in 12 cases Original Papers

    Gasparetto, Emerson L.; Souza, Carolina A.; Tazoniero, Priscilla; Davaus, Taisa; Escuissato, Dante L.; Marchiori, Edson

    Resumo em Inglês:

    The aim of this study was to present the clinical and high-resolution CT scan findings of angioinvasive pulmonary aspergillosis (APA) in 12 patients who underwent allogeneic bone marrow transplantation (BMT). The CT scans were reviewed by three chest radiologists who assessed the pattern and distribution of findings by consent. There were 7 (58%) female and 5 (42%) male patients, with aging between 5 and 50 years (average of 26 years). All patients were submitted to BMT for the treatment of hematological conditions. The diagnosis of APA was defined between 5 and 373 days after BMT, with average of 111 days. Three cases (25%) were diagnosed in the neutropenic phase after the BMT, five (42%) in the early phase and four patients in the late phase post-BMT. Regarding high-resolution CT (HRCT) scan findings, nodules were found in 75% of the cases (9/12), most of the cases with more than 10 lesions (7/9) and of centrilobular localization (6/9). Consolidations were identified in seven patients (58%), being single in six, and commonly presenting ill defined borders (n=3) and subsegmental localization (n=5). Ground glass attenuation was found in six patients (50%). The halo sign was observed in nine cases (75%). Cavitations were seen in two air-space consolidations and one large nodule (2.5 cm). Patients submitted to BMT presenting respiratory symptoms and nodules or consolidations with halo sign at HRCT scan need to have the diagnosis of angioinvasive pulmonary aspergillosis included in all the post BMT phases.
  • Clinical tomographic correlations of 220 patients with neurocisticercosis, Bahia, Brazil Original Papers

    Andrade-Filho, Antônio de Souza; Figuerôa, Luiz Frederico da Silva; Andrade-Souza, Victor Mascarenhas

    Resumo em Inglês:

    Neurocysticercosis (NCC) is a common parasitic disease in our region, presenting diversity of neurological symptoms and signs. The present study has as primary objective an evaluation of the NCC's clinical and epidemiological profile within Bahia State, by means of a prospective study of 220 patients diagnosed from March 1988 to March 1999, with a follow-up of six months. Exams, such as Computed Cranial Tomography Scan (CT), Cerebral Spine Fluid (CSF) and Electroencephalogram (EEG), were accomplished in three distinct moments of these patients' evolution: at starting or diagnostic point (zero time), at after-intervention period (one month after treatment), and at control period (six months after treatment).
  • Hepatitis C treatment: shorter and better? Review Papers

    Araújo, Evaldo Stanislau Affonso de; Courtouké, Cláudia; Barone, Antonio Alci

    Resumo em Inglês:

    Herein, we present a synthesis of two publications that evaluate an abbreviated therapeutic approach to treating chronic hepatitis C virus (HCV) infection. Based on those publications, we discuss the use of the early virologic response (EVR) as a tool for the optimized management of patients under treatment, as well as reviewing concepts of HCV viral kinetics. The fourth-week EVR, characterized by HCV RNA dropping to undetectable levels, allows individuals infected with HCV genotype 1 and presenting low baseline viral loads to be treated with the combination of pegylated interferon and ribavirin for 24 weeks, whereas individuals infected with HCV genotypes 2 or 3 can be treated for only 12 weeks. Therefore, by adopting abbreviated treatment regimens optimized through early prediction of sustained viral response, it is possible to increase the number of patients treated without incurring the excess costs related to high rates of treatment failure and management of adverse outcomes, as well as avoiding the risks of unnecessarily exposing patients to drugs that have the potential to be highly toxic.
  • H5N1 avian influenza virus: an overview Review Papers

    Proença-Módena, José Luiz; Macedo, Izolete Santos; Arruda, Eurico

    Resumo em Inglês:

    Avian influenza virus (H5N1) emerged in Hong Kong in 1997, causing severe human disease. In recent years, several outbreaks have been reported in different parts of Asia, Europe and Africa, raising concerns of dissemination of a new and highly lethal influenza pandemic. Although H5N1 has not been capable of sustaining human-to-human transmission, the ability of the virus to undergo variation due to mutations and reassortment, clearly poses the possibility of viral adaptation to the human species. For this reason the World Health Organization has established that we are now in a phase of pandemic alert. Preparing for an influenza pandemic involves a great deal of awareness necessary to stop initial outbreaks, through the use of case recognition, sensitive and rapid diagnostic methods, appropriate therapeutic and preventive measures to reduce spread. Influenza pandemic preparedness involves coordinated pharmacologic and vaccinal strategies, as well as containment measures such as travel restrictions and quarantine approaches.
  • Applicability of the national nosocomial infections surveillance system risk index for the prediction of surgical site infections: a review Review Papers

    Ercole, Flávia Falci; Starling, Carlos Ernesto Ferreira; Chianca, Tânia Couto Machado; Carneiro, Mariângela

    Resumo em Inglês:

    This review outlines the evolution of risk rates of surgical site infection adopted by the Study on the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infections Surveillance (NNIS) system, and evaluates their advantages and limitations. The types of surgical procedures for which the NNIS index has proven to be an efficient system for the classification of patients are presented. The necessity of adapting the NNIS index to take into account specific characteristics associated with hospitals and practices in various regions and countries is stressed. The requirement for further testing and development of the rate concerning specific procedures, particularly those involving orthopaedic surgery, is discussed.
  • Pathology and pathophysiology of pulmonary manifestations in leptospirosis Review Papers

    Dolhnikoff, Marisa; Mauad, Thais; Bethlem, Eduardo P.; Carvalho, Carlos Roberto Ribeiro

    Resumo em Inglês:

    Leptospirosis is a re-emerging zoonosis occurring as large outbreaks throughout the world caused by Leptospira interrogans. The incidence of pulmonary involvement in leptospirosis has been reported to be increasing in the last years, affecting up to 70% of the patients. Alveolar hemorrhage presented as dyspnea and hemoptysis is the main pulmonary manifestation. The emergence of massive hemoptysis and acute respiratory distress syndrome has characterized the recent changes reported in the clinical patterns of leptospirosis. The pulmonary involvement has been emerged as a serious life threat, becoming the main cause of death due to leptospirosis in some countries. In this review we present the main clinical and pathological manifestations of pulmonary involvement in leptospirosis, with special focus on recent data concerning the pathophysiological mechanisms underlying lung injury.
  • Leishmania mexicana infection of the eyelid in a traveler to Belize Case Reports

    Vinetz, Joseph M.; Soong, Lynn

    Resumo em Inglês:

    A 50 year-old man, a United States resident, presented in Texas with a violaceous non-ulcerating lesion, involving the entire lower eyelid. The patient had traveled to a jungle area of Belize several hours drive from the capital city. Leishmania mexicana was isolated. The lesion only partially resolved after an initial course of sodium stibogluconate, requiring retreatment. At two years of follow-up, there was no relapse. The parasite isolated from the patient caused a progressive, non-ulcerating lesion in an experimental mouse footpad infection. This is an unusual case of cutaneous leishmaniasis in a traveler. Travelers must be educated about personal protective measures to prevent exotic infections acquired during travel.
  • Paragonimiasis: first case reported in Brazil Case Reports

    Lemos, Antônio Carlos Moreira; Coelho, João Carlos; Matos, Eliana Dias; Montal, Guilherme; Aguiar, Fernanda; Badaró, Roberto

    Resumo em Inglês:

    The authors present a case from a 59 years old white female Brazilian patient, based in Salvador-Bahia, Brazil's northeastern side area, who experienced irritative cough and progressive dyspnea, and, after 18 months, was admitted to a hospital with respiratory insufficiency. The physical exam showed diffuse rales in both hemithoraces. Initial leukogram showed 14,400 cells/mL with 14% of eosinophils and chest X-ray showed peribronchovascular infiltrate, predominating in the lower half of the lung fields, and small opaque nodules. The high-resolution computed tomography scan of the chest (HRCT) presented compatible pattern with airways disease, especially from the small airways, with air trapping, tree sprouting images, central lobular nodules and bronchiectasis, making the results compatible with bronchiolitis and bronchiectasis. The transbroncho biopsy unveiled granulomatous lesion with necrosis, where was noticed a structure compatible to a parasitic case, and the research of the parasite eggs in the sputum was positive to paragonimus. After the praziquantel use, the patient presented a thick ferruginous expectoration and the result for BAAR examination was positive. The PCR exam and the sputum culture confirmed M. tuberculosis, and then the treatment for M. tuberculosis was initiated. The authors warn that this infection may have been a consequence of economics globalization process, where the importation of parasitized crustaceans might be the cause. However, there is the need of an accurate examination for the possibility of paragonimus specimens in this area of Brazil.
  • Thoracic actinomycosis: report of a patient with advanced-stage disease Case Reports

    Santos, José Wellington Alves dos; Zambenedetti, Ricardo Morgental; Mann, Keli Cristina; Cibin, Luiz Fenando Ximenes

    Resumo em Inglês:

    The authors describe a case of advanced thoracic actinomycosis. A 44-year-old man with previous episodes of productive cough with purulent sputum, fever, chest pain and subcutaneous nodules on the left hemithorax was admitted with complaints of lumbar pain irradiating into left lower limb and presence of mass lesion on the left lumbar region. Imaging evaluations were obtained and the patient underwent left lower lobectomy. Histopathology, microscopic examination and anaerobic culture of the resected material diagnosed thoracic actinomycosis.
  • Bilateral afrenal nodules due to histoplasmosis in an elderly Case Reports

    Carvalho, Flávio Pedreira de Freitas de; Curiati, José Antônio Esper; Mauad, Thaís; Incerti, Milena Mendes; Jacob Filho, Wilson

    Resumo em Inglês:

    We report a case history of an 84-year-old elderly male patient that presented with a clinical picture suggestive of adrenal failure and bilateral adrenal nodules detected by abdominal computed tomography. A fine needle-guided biopsy was inconclusive for achieving a final diagnosis. The patient died due to septic shock and the autopsy disclosed histoplasmosis with extensive bilateral necrosis of the adrenal glands. Although the adrenal involvement in chronic disseminated histoplasmosis has been described, there have been few reports of the infection being associated with adrenal insufficiency.
  • Respiratory syncytial virus rhinosinusitis in intensive care unit patients Case Reports

    Silva, Alexandre Rodrigues da; Park, Marcelo; Boas, Lucy S. Vilas; Machado, Clarisse Martins

    Resumo em Inglês:

    This study reported a case of rhinosinusitis for Respiratory Syncytial Virus in Intensive Care Unit patient. The settings were Intensive Care Unit at Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. One female HIV-infected patient with respiratory failure and circulatory shock due to splenic and renal abscesses, who developed rhinosinusitis caused by RSV and bacteria. Respiratory viruses can play a pathogenic role in airways infection allowing secondary bacterial overgrowth.
  • Peritonitis due to Penicillium and Enterobacter in a patient receiving continuous ambulatory peritoneal dialysis Case Reports

    Böhlke, Maristela; Souza, Person Antunes de; Menezes, Adriane Maria Delgado; Roth, Juliana Martino; Kramer, Luiz Roberto

    Resumo em Inglês:

    Infectious peritonitis is a common complication of continuous ambulatory peritoneal dialysis (CAPD). Polymicrobial peritonitis accounts for about 8% of the peritonitis episodes and involves fungi in 9% to 33% of cases. We report the known first case of polymicrobial peritonitis in which Penicillium sp. was one of the organisms cultured and the ninth case of Penicillium peritonitis in CAPD.
  • End-stage renal disease due to delayed diagnosis of renal tuberculosis: a fatal case report Case Reports

    Daher, Elizabeth De Francesco; Silva Júnior, Geraldo Bezerra da; Damasceno, Renata Trindade; Santos, Gustavo Martins dos; Corsino, Germana Alves; Silva, Sônia Leite da; Gutiérrez-Adrianzén, Oswaldo Augusto

    Resumo em Inglês:

    Renal TB is difficult to diagnose, because many patients present themselves with lower urinary symptoms which are typical of bacterial cystitis. We report a case of a young woman with renal TB and ESRD. She was admitted with complaints of adynamia, anorexia, fever, weight loss, dysuria and generalized edema for 10 months. At physical examination she was febrile (39ºC), and her abdomen had increased volume and was painful at palpation. Laboratorial tests showed serum urea=220mg/dL, creatinine=6.6mg/dL, hemoglobin=7.9g/dL, hematocrit=24.3%, leukocytes=33,600/mm³ and platelets=664,000/mm³. Urinalysis showed an acid urine (pH=5.0), leukocyturia (2+/4+) and mild proteinuria (1+/4+). She was also oliguric (urinary volume <400mL/day). Abdominal echography showed thick and contracted bladder walls and heterogeneous liquid collection in the left pelvic region. Two laparotomies were performed, in which abscess in pelvic region was found. Anti-peritoneal tuberculosis treatment with rifampin, isoniazid and pyrazinamide was started. During the follow-up, the urine culture was found to be positive for M. tuberculosis. Six months later the patient had complaints of abdominal pain and dysuria. New laboratorial tests showed serum urea=187mg/dL, creatinine=8.0mg/dL, potassium=6.5mEq/L. Hemodialysis was then started. The CT scan showed signs of chronic nephropathy, dilated calyces and thinning of renal cortex in both kidneys and severe dilation of ureter. The patient developed neurologic symptoms, suggesting tuberculous meningoencephalitis, and died despite of support measures adopted. The patient had ESRD due to secondary uropathy to prolonged tuberculosis of urinary tract that was caused by delayed clinical and laboratorial diagnosis, and probably also due to inadequate antituberculous drugs administration.
  • Primary isolated gingival tuberculosis Case Reports

    Rodrigues, Gabriel; Carnelio, Sunitha; Valliathan, Maanna

    Resumo em Inglês:

    Tuberculosis of the oral cavity is a rare event and when present is usually secondary to pulmonary tuberculosis. We present a case of a 33-year-old male patient who presented with symptoms of gingivitis. Local examination revealed multiple ulcers and a few nodules over the gingiva. A nodule biopsy was consistent with the diagnosis of gingival tuberculosis. The patient had no evidence of tuberculosis any where else in the body. Medical treatment was curative. As this condition is very rare, it is often over looked as it is never thought as a common clinical diagnosis. A biopsy is mandatory to establish diagnosis. The relevant literature is reviewed.
  • The use of monoclonal antibody (Rituximab) in the treatment of type II mixed cryoglobulinemia Case Reports

    Rego, Thiago Carlos Gonçalves; Massumoto, Celso Mitsushi; Batista, Rodrigo Siqueira; Moura, Larissa Hanauer de; Soares, Lygia Maria Costa; Gomes, Andréia Patrícia

    Resumo em Inglês:

    Anti-CD20 monoclonal antibody has been successfully used to treat several self-immune diseases. The authors report the case of a 71 year-old female patient under the use of pegylated form of interferon á associated with ribavirin for the treatment of hepatitis C, who, after concluding the therapeutic program - negative Polymerase Chain Reaction (PCR) - developed a severe cutaneous vasculitis, receiving the diagnostic of type II mixed cryoglobulinemia. Four sessions of plasmapheresis were prescribed along the period of 11 days, with no result. The choice made was to administer anti-CD 20 monoclonal antibody (rituximab), 375 mg/m², per week, during four consecutive weeks. One could observe fast recovery from the purpura, as well as total remission of urticaria.
  • Multiorgan involvement due to cytomegalovirus infection in AIDS Case Reports

    Majumder, Shounak; Mandal, Sanjay K.; Bandyopadhyay, Dipanjan; Chowdhury, Subhasis Roy; Chakraborty, Partha P.; K., Mitra

    Resumo em Inglês:

    Cytomegalovirus (CMV) infection is a relatively late complication of AIDS. Like other viruses contributing to co-morbidity of HIV infection, cytomegalovirus has the propensity to cause multiorgan involvement. We report the case of a 34-year-old seropositive man who presented with bilateral lower limb weakness and symptomatic pallor. He was already on antiretroviral drugs for a month prior to presentation. Detailed clinical examination and laboratory investigations revealed cytomegalovirus polyradiculoneuropathy associated with bone marrow dysplasia. Dysplasia of haematopoeitic cell lines occurs in 30% to 70% of HIV infected patients, and is often indistinguishable from myelodysplastic syndrome. However, in our case, the bone marrow picture reverted back to normal with treatment of the CMV infection, pointing to a possible role of CMV as the causative agent of bone marrow dysplasia. Moreover, CMV has been incriminated as a pathogen producing the immune reconstitution inflammatory syndrome. The onset of the disease in our case one month after initiation of HAART strongly raises the possibility of this being a case of CMV related IRIS. This is the first reported case where IRIS has presented with CMV polyradiculoneuropathy and bone marrow dysplasia. We would like to highlight that in today's era of HIV care, clinicians should be aware of the possibility of multiorgan involvement by CMV, for appropriate management of this disease in the background of AIDS.
  • Transverse myelitis caused by varicella zoster: case reports Case Reports

    Yýlmaz, Sema; Köseoðlu, Hamide Kart; Yücel, Eftal

    Resumo em Inglês:

    Transverse myelitis is a group of disorders characterized by focal inflammation of the spinal cord and results in loss of motor and sensory function below the level of injury. Occurrence of this condition during or following varicella infection is uncommon. This report describes two cases of transverse myelitis caused by varicella zoster.
  • José Borges Sales (1911-2006) Obituary

    Sousa, Anastácio de Queiroz; Menezes, Dalgimar Beserra de
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