• Molecular characterization of viruses associated with gastrointestinal infection in HIV-positive patients Original Article

    Silva, Raquel C; Benati, Fabrício J; Pena, Giselle PA; Santos, Norma

    Abstract in English:

    BACKGROUND: Diarrhea is a major cause of morbidity and mortality among HIV-infected patients worldwide. OBJECTIVE: We sought to determine the frequency of viral gastrointestinal infections among Brazilian HIV-infected patients with diarrhea. METHODS: A collection of 90 fecal specimens from HIV-infected individuals with diarrhea, previously tested for the presence of bacteria and parasite was analyzed by polymerase chain reaction and sequence analysis for the presence of enteric viruses such as astrovirus, norovirus, rotavirus groups A, B and C, adenovirus, herpes simplex virus, Epstein-Barr virus, cytomegalovirus, and human bocavirus. RESULTS: Twenty patients (22.2%; n = 90) were infected with parasites (11 single infections and nine coinfected with virus). Enteropathogenic bacteria were not found. Virus infections were detected in 28.9% (26/90) of the specimens. Cytomegalovirus was the most common virus detected (24.4%; 22/90). Coinfections with viruses and/or parasite were observed in 10 (11.1%) samples. CONCLUSION: Gastrointestinal virus infections were more frequent than parasitic or bacterial infections in this patient population.
  • Detection and characterization of human rotavirus in hospitalized patients in the cities of Ponta Grossa, Londrina and Assai - PR, Brazil Original Article

    Nozawa, Carlos M; Kerntopf, Gustavo Franthesco; Czernisz, Érika da Silva; Albuquerque, Daniele; Romanin, Priscila; Freitas, José Felipe Eliseu; Santos, Norma; Benati, Fabrício José; Pietruchinski, Eduardo; Linhares, Rosa Elisa Carvalho

    Abstract in English:

    Acute diarrheal disease is still one of the major public health problems worldwide. Rotaviruses (RV) are the most important viral etiologic agents and children under five years of age are the target population. OBJECTIVE: To investigate the rate of RV infection in hospitalized patients due to acute diarrhea in the cities of Ponta Grossa, Londrina and Assai - Paraná. METHODS: Latex agglutination (LA); immunochromatography (ICG); polyacrylamide gel electrophoresis (PAGE) and negative staining electron microscopy (ME) tests were used to detect the virus. For the genotyping, RT-PCR and RT-PCR-ELISA were used, respectively, for NSP4 and VP4/VP7. RESULT: Out of 124 samples there were 69 positive stool samples for RV, for at least one of the used tests, 67 of them being RV group A (RV-A). Overall, most of the RV positive stool samples came from children under thirteen years of age. However, 12 positive cases occurred in patients aged 13 years or above, including an 81-year old patient. CONCLUSION: The data showed similar electropherotypes and genotypes G, P and NSP4 of the inland wild circulating strains of RV.
  • Causes of death among people living with HIV/AIDS in Brazil Original Article

    Rezende, Erika Luiza Lage Fazito; Vasconcelos, Ana Maria Nogales; Pereira, Mauricio Gomes

    Abstract in English:

    BACKGROUND: The monitoring of the underlying causes of death in people living with HIV/AIDS is important so that actions to reduce morbidity and mortality can be taken. OBJECTIVE: To describe the temporal trends of underlying causes of death among people living with HIV/AIDS between 2000 and 2007 in Brazil and to identify factors associated with it. METHODS: The Mortality Information System data for deaths occurred in Brazil between 2000 and 2007 that contained reference to HIV/AIDS in any of the death certificate fields was analyzed. Temporal trends of the underlying cause of death were studied. Differences in the underlying cause of death according to gender, age, region of residence, level of education, certifying officer, race and year of death were verified. RESULTS: Between 2000 and 2007 the percentage of deaths not related to HIV/AIDS among people living with HIV/AIDS increased from 2.5% to 7.0%. People with higher level of formal education, living in the South-East region of Brazil and aged under 13 or over 60 years old were more likely to have their underlying cause of death reported as not related to HIV/AIDS. CONCLUSION: The results suggest the importance of implementing actions aimed at improving the quality of life of PLWHA, and which could include behavioral changes, such as smoking and alcoholism cessation, early screening to detect neoplasms and the monitoring of chronic conditions, such as diabetes. That is to say, the need exists to integrate the actions of HIV/AIDS programs with other public health programs.
  • Distribution of erm genes and low prevalence of inducible resistance to clindamycin among staphylococci isolates Original Article

    Coutinho, Vivian de Lima Spode; Paiva, Rodrigo Minuto; Reiter, Keli Cristine; de-Paris, Fernanda; Barth, Afonso Luis; Machado, Alice Beatriz Mombach Pinheiro

    Abstract in English:

    INTRODUCTION: Resistance to macrolides, lincosamides and streptogramins B (MLS B antibiotics) in staphylococci may be due to modification in ribosomal target methylase encoded by erm genes. The expression of MLS B resistance lead to three phenotypes, namely constitutive resistance (cMLS B), inducible resistance (iMLS B), and resistance only to macrolides and streptogramins B (MS B). The iMLS B resistance is the most difficult to detect in the clinical laboratory. OBJECTIVE: This study investigated the expression of MLS B resistance and the prevalence of the erm genes among 152 clinical isolates of Staphylococcus aureus and coagulase-negative Staphylococcus (CNS) from Hospital de Clínicas de Porto Alegre. METHODS: Primary MLS B resistance was detected by the disk diffusion method. Isolates with iMLS B phenotype were tested by double-disk induction method. All isolates were tested by a genotypic assay, PCR with specific primers. RESULTS: A total of 46.7% of staphylococci were positive for cMLS B; 3.3% for iMLS B and 3.3% for MS B. One or more erm genes were present in 50.1% of isolates. The gene ermA was detected in 49 isolates, ermC in 29 and ermB in 3. CONCLUSION: The prevalence of the ermA, ermB and ermC genes were 29.6%, 17.1% and 0.66% respectively, and constitutive resistance was the most frequent as compared to the other two phenotypes.
  • Molecular detection of cytomegalovirus, herpes simplex virus 2, human papillomavirus 16-18 in Turkish pregnants Original Article

    Dinc, Bedia; Bozdayi, Gulendam; Biri, Aydan; Kalkanci, Ayse; Dogan, Bora; Bozkurt, Nuray; Rota, Seyyal

    Abstract in English:

    OBJECTIVE: Human cytomegalovirus (CMV) is the most common cause of viral intrauterine infections in the world. Herpes simplex virus type 2 (HSV-2) and human papillomavirus (HPV) are the main agents of viral sexually transmitted diseases, which cause genital ulcers and genital warts, respectively. HPV infection has been linked to the majority of the anogenital malignancies. The aim of this study was to detect the existence of CMV, HSV-2 and HPV type 16-18 in Turkish pregnants by using sensitive molecular assays. METHODS: One hundred thirty-four women (18-41 years old; mean age ± SD: 27 ± 8) applied to outpatient clinic of Obstetrics and Gynecology, in between 18th - 22nd weeks of their pregnancy and a control group of 99 healthy women (15-39 years old; mean age ± SD: 24 ± 8) were included in the study. Cervical smear samples were used for DNA extraction. CMV, HSV-2 and HPV 16-18 detections were carried out by real time PCR and in house PCR method, respectively. RESULTS: Three patients (3/134; 2.2%) were found to be positive for each HPV and HSV-2. Dual infection with HPV and HSV was found in just one patient. HPV 18 was detected in all positive samples. CMV was found to be positive in two patients (2/134; 1.4 %). CONCLUSION: HPV, HSV and CMV must be screened due to high prevalence of these viruses in pregnants by using sensitive molecular methods.
  • Dyslipidemia in HIV-infected individuals Original Article

    Sprinz, Eduardo; Lazzaretti, Rosmeri Kuhmmer; Kuhmmer, Regina; Ribeiro, Jorge Pinto

    Abstract in English:

    Metabolic complications continue to play a major role in the management of HIV infection. Dyslipidemia associated with HIV infection and with the use of combined antiretroviral therapy includes elevations in triglycerides, reduced high-density cholesterol, and variable increases in low-density and total cholesterol. The association between dyslipidemia and specific antiretroviral agents has been underscored. Multiple pathogenic mechanisms by which HIV and antiretroviral agents lead to dyslipidemia have been hypothesized, but they are still controversial. The potential clinical and pathological consequences of HIV-associated hyperlipidemia are not completely known, but several studies reported an increased risk of coronary artery disease in HIV-positive individuals receiving combined antiretroviral therapy. HIV-infected persons who have hyperlipidemia should be managed similarly to those without HIV infection in accordance with the National Cholesterol Education Program. Life style changes are the primary target. Statins and fibrates and/or modification in antiretroviral therapy are possible approaches to this problem.
  • Typhidot M and Diazo test vis-à-vis blood culture and Widal test in the early diagnosis of typhoid fever in children in a resource poor setting Original Article

    Beig, Farzana K; Ahmad, Faraz; Ekram, Mohd; Shukla, Indu

    Abstract in English:

    OBJECTIVE: Typhoid fever is a major public health problem. A test which is simple, reliable and can be carried out in small laboratories is the need of the hour. We prospectively evaluated typhidot M and Diazo tests vis-à-vis blood culture and Widal test in children. METHODS: Patients aged 6 months to 12 years, having fever of more than four days duration with clinical suspicion of typhoid fever were enrolled. Patients in whom other diagnosis was made served as control. The tests under scrutiny were validated against blood culture and then all the four tests were evaluated among patients who presented in the first week of illness. RESULTS: Blood culture was positive in only 27.3% of the cases. Among these culture positive cases, typhidot M test had the highest sensitivity, specificity, PPV and NPV of 90% (95% CI = 74.4-96.5), 100% (95% CI = 90.1-100), 100% (95% CI = 87.5-100), and 92.1% (95% CI = 79.2-97.3) respectively. Diazo test ranked next with sensitivity, specificity, PPV and NPV of 86.7% (95% CI = 70.3-94.7), 85.7% (95% CI = 70.6-93.7), 83.9% (95% CI = 67.4-92.9), 88.2% (95% CI = 73.4-95.3) respectively. Among clinically suspected typhoid cases, the overall sensitivity, of blood culture, Widal, typhidot M, Diazo was 27.3% (95% CI = 19.8- 36.3), 64.6% (95% CI = 55.3-72.9), 89.1% (95% CI = 81.9-93.7), 80.9% (95% CI = 72.6-87.2) respectively. In the first week of illness, typhidot M showed the best sensitivity [86.2% (95% CI = 69.4-94.5)] followed by Diazo [79% (95% CI = 61.6-90.2)], Widal [41.4% (95% CI = 25.5-59.3)] and blood culture [31% (95% CI = 17.3-49.2)]. CONCLUSION: Both Typhidot M and Diazo are good screening tests for the diagnosis of typhoid fever. Typhidot M is superior to Diazo but the latter is more suitable to resource poor settings being economic and easy to perform.
  • Assessment of the effectiveness of a home-based care program for patients coinfected with tuberculosis and human immunodeficiency virus after discharge from a reference hospital in South-Eastern Brazil Original Article

    Bento, Carlos Alessandro Plá; Pedroso, Enio Roberto Pietra

    Abstract in English:

    The effectiveness of tuberculosis treatment delivered by a home-based care program to patients coinfected with HIV was compared with that of a service provided by outpatient departments. A retrospective study was made of a cohort of coinfected patients discharged from hospital between January 1998 and December 2002 who had been followed-up for one year within one of these programs. Two-hundred-and-forty-three patients who met the inclusion criteria were grouped according to their treatment program (group 1 received home-based care; group 2 attended outpatient departments) and then paired one-to-one across the groups by gender, age and level of education. Only 48 patients from each group could be paired. Apart from the duration of HIV infection, there were no statistically significant differences (P < 0.05) between patients in the two groups with respect to social-demographic status and clinical or laboratory characteristics. In group 1, 75.0% of patients attained successful tuberculosis treatment compared with 72.9% of those in group 2 (P = 0.816). Treatment was abandoned by 22.9% of patients in group 1 and by 54.2% of those in group 2 (P = 0.008). The death rate within one year after discharge was 20.8% for group 1 compared with 6.3% for group 2 (P = 0.334). Although both programs achieved a similar success rate in the treatment of tuberculosis, patients receiving outpatient care were three to eight-times more likely to abandon the program. The importance of assigning patients at-risk of abandoning treatment to a home-based care program after discharge from hospital is emphasized.
  • Seropositivity rates for toxoplasmosis, rubella, syphilis, cytomegalovirus, hepatitis and HIV among pregnant women receiving care at a public health service, São Paulo state, Brazil Brief Communication

    Gonçalves, Márcia Aparecida dos Santos; Matos, Cinara de Cássia Brandão de; Spegiorin, Lígia Cosentino Junqueira Franco; Oliani, Denise Cristina Mós Vaz; Oliani, Antonio Hélio; Mattos, Luiz Carlos de

    Abstract in English:

    Infectious and parasitic diseases affecting women during their reproductive age may result in vertical transmission. The aim of this study was to determine the seroprevalence for TORSCH among pregnant women receiving care at a university hospital. Records of 574 pregnant women who received medical attention from January 2006 to December 2007 were assessed. The mean age was 27.2 ± 6.5 years ranging from 13 to 44. The results of the immunodiagnostic tests were: 62.0% (345/556) for IgG and 3.4% (19/556) for IgM anti-T. gondii; 93.1% (433/465) for IgG and 0.6% (3/465) for IgM anti-rubella; 0.9% (5/561) for VDRL; 1.8% (10/554) for HBsAg; 0.7% (4/545) for anti-HCV and 2.1% (11/531) for HIV. In conclusion, the results of immunodiagnostic tests for the TORSCH panel among pregnant women attending a perinatal service of a university hospital are in agreement with those reported by previous studies and by governmental sources.
  • The effects of nitric oxide on the immune response during giardiasis Review Article

    Pavanelli, Wander Rogério; Gutierrez, Fredy Roberto Salazar; Silva, Jean Jerley Nogueira da; Costa, Ivete Conchon; Menezes, Maria Claudia Noronha Dutra de; Oliveira, Francisco José de Abreu; Itano, Eiko Nakagawa; Watanabe, Maria Angélica Ehara

    Abstract in English:

    Nitric oxide (NO) is a free radical synthesized from L-arginine by different isoforms NO-synthases. NO possesses multiple and complex biological functions. NO is an important mediator of homeostasis, and changes in its generation or actions can contribute or not to pathological states. The knowledge of effects of NO has been not only important to our understanding of immune response, but also to new tools for research and treatment of various diseases. Knowing the importance of NO as inflammatory mediator in diverse infectious diseases, we decided to develop a revision that shows the participation/effect of this mediator in immune response induced against Giardia spp. Several studies already demonstrated the participation of NO with microbicidal and microbiostatic activity in giardiasis. On the other hand, some works report that Giardia spp. inhibit NO production by consuming the intermediate metabolite arginine. In fact, studies in vitro showed that G. lamblia infection of human intestinal epithelial cells had reduced NO production. This occurs due to limited offer of the crucial substrate arginine (essential aminoacid for NO production), consequently reducing NO production. Therefore, the balance between giardial arginine consumption and epithelial NO production could contribute to the variability of the duration and severity of infections by this ubiquitous parasite.
  • Endocrine and metabolic disorders in HTLV-1 infected patients Review Article

    Alves, Cresio; Dourado, Luciano

    Abstract in English:

    Human T-cell leukemia virus type 1 (HTLV-1) infection is endemic in Japan and several countries in South America, Caribbean and Africa. Endocrine and metabolic disorders have been variably reported to be associated with human T-cell leukemia virus type 1 (HTLV-1) infection. Therefore, the aim of this article was to critically evaluate the current knowledge of the endocrine and metabolic disorders associated with HTLV-1 infection. The literature search used PubMed, Web of Science, and LILACS databases in the past 10 years, utilizing, in various combinations, the following keywords: HTLV-1, adult T-cell leukemia, diabetes mellitus, GLUT-1, osteoporosis, hypercalcemia, autoimmune thyroid disorders, diabetes insipidus, inappropriate antidiuretic hormone secretion; pseudohypoparathyroidism; pseudopseudohypoparathyroidism. The proven endocrine manifestations of the HTLV-1 infection are calcium disorders which occur in some patients with acute HTLV-1/Adult T-cell leukemia/lymphoma. The few reports about thyroid, parathyroid, antidiuretic hormone and diabetes mellitus are insufficient to prove a causal association with HTLV-1 infection. The evidence for an association between endocrine disorders and HTLV-1 infection in general, and in asymptomatic patients is lacking. Given all these uncertainties, the endocrine expression of the HTLV-1 infection composes a promising research line for understanding the pathophysiology of this infection
  • Kikuchi-Fujimoto disease: an unusual association with acute renal failure Review Article

    Silva, Amanda Feliciano da; Focaccia, Roberto; Oliveira, Allan Constantino de; Sementilli, Angelo; Reis, Gelvana Flávio Barreto

    Abstract in English:

    Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis of unknown etiopathogenesis, is a self-limited disease which frequently appears as feverish lymphadenomegaly, thus creating the need for differential diagnosis with lymphoma, systemic lupus erythematosus (SLE), infectious mononucleosis, cat-scratch disease, and toxoplasmosis with lymphonodal impairment. However, there are cases in which it may evolve with complications such as aseptic meningitis, cerebellar ataxia, and aseptic myocarditis. We are presenting a case of a 24-year-old man who had an initial picture of arthralgia, evening fever and adenomegaly. Kikuchi disease was diagnosed through lymph node biopsy with immunohistochemistry and evolves with severe systemic manifestations, such as pericarditis with cardiac tamponade, pneumonitis, hepatitis, and acute kidney failure - the latter has not been reported in literature yet. There was significant improvement of the clinical picture with prednisone
  • Schistosomal peritonitis secondary to perforated appendicitis Case Report

    Mazigo, Humphrey D; Giiti, Geofrey C; Zinga, Maria; Heukelbach, Jorg; Rambau, Peter

    Abstract in English:

    In Tanzania, Schistosoma mansoni is endemic and causes intestinal schistosomiasis which affects various internal organs. However, worldwide there have been very few reports of cases of peritonitis due to schistosomal appendicitis. Here we report a rare case of schistosomal appendicitis with peritonitis in a 33 year-old male patient who recovered quickly after surgery
  • Candida tropicalis as an emerging pathogen in Candida meningitis: case report and review Case Report

    Goldani, Luciano Z; Santos, Rodrigo P

    Abstract in English:

    Candida species are an uncommon cause of meninigitis. Given the rarity of this infection, the epidemiology, prognosis, and optimal therapy for Candida meningitis are poorly defined. The authors report on a paraplegic patient due to spinal cord injury who developed C. tropicalis meningitis. In addition, we review and discuss other reported cases of C. tropicalis meningitis in the medical literature
  • Native valve endocarditis and femoral embolism due to Granulicatella adiacens: a rare case report Case Report

    Vandana, KE; Mukhopadhyay, C; Rau, NR; Ajith, V; Rajath, P

    Abstract in English:

    The fastidious Gram-positive cocci Granulicatella adiacens, previously known as nutritionally variant streptococci (NVS) are unusual but significant cause of endocarditis due to increased mortality and morbidity. Difficulties in reaching correct bacteriological identification, increased resistance to beta-lactam antibiotics and macrolides and complicated clinical course have contributed to problems in management of cases of infective endocarditis caused by this bacterium. We present the first Indian case of endocarditis with arterial embolus by G. adiacens in an elderly male with no preexisting cardiac abnormality
  • Severe disseminated tuberculosis in a 4-year-old girl Clinical Images

    Rey, Luis Carlos; Sousa, Anastacio Queiroz
  • Active pulmonary tuberculosis manifesting with idiopathic thrombocytopenic purpura: a rare presentation Letter to the Editor

    Tabarsi, Payam; Merza, Muayad Aghali; Marjani, Majid
  • An unusual presentation of brucellosis: acute hepatitis Letter to the Editor

    Uluğ, Mehmet; Celen, Mustafa Kemal; Ayaz, Celal
  • Neurological opportunistic diseases in HIV infected patients in a western hospital of Venezuela, 2007 -2009 Letter to the Editor

    Herrera-Martínez, Aura D; Herrera-Martínez, Yiraldine; Pineda, Antonio Maria
  • Subacromial bursitis related to HIV infection: case report Letter to the Editor

    Ejnisman, Benno; Figueiredo, Eduardo Antônio de; Terra, Bernardo Barcellos; Lima, Ana Lucia L Munhoz; Uip, David E
  • Is it acalculous cholecystitis or reactive/viral pericholecystits in acute hepatitis? Letter to the Editor

    Debnath, Jyotindu; Mathur, Ankit
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