Revista do Instituto de Medicina Tropical de São Paulohttps://www.scielo.br/journal/rimtsp/feed/2024-01-02T20:27:02.011000ZUnknown authorVol. 66 - 2024WerkzeugPost-discharge all-cause mortality in COVID-19 recovered patients hospitalized in 2020: the impact of chronic kidney disease10.1590/S1678-99462024660012024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZLomba, Guilherme Schittine BezerraSilva, Pedro Henrique Abreu daRosário, Natalia Fonseca doMedeiros, ThaliaAlves, Lilian SantosSilva, Andrea AliceAlmeida, Jorge ReisLugon, Jocemir Ronaldo
<em>Lomba, Guilherme Schittine Bezerra</em>;
<em>Silva, Pedro Henrique Abreu Da</em>;
<em>Rosário, Natalia Fonseca Do</em>;
<em>Medeiros, Thalia</em>;
<em>Alves, Lilian Santos</em>;
<em>Silva, Andrea Alice</em>;
<em>Almeida, Jorge Reis</em>;
<em>Lugon, Jocemir Ronaldo</em>;
<br/><br/>
ABSTRACT In Brazil, the COVID-19 burden was substantial, and risk factors associated with higher in-hospital mortality rates have been extensively studied. However, information on short-term all-cause mortality and the factors associated with death in patients who survived the hospitalization period of acute SARS-CoV-2 infection is limited. We analyzed the six-month post-hospitalization mortality rate and possible risk factors of COVID-19 patients in a single center in Brazil. This is a retrospective cohort study focused on a six-month follow-up. The exclusion criteria were death during hospitalization, transference to another hospital, and age under 18. We collected data from the charts of all hospitalized patients from March 2020 to December 2020 with a positive RT-PCR test for SARS-CoV-2, resulting in a sample size of 106 patients. The main outcome was death after hospitalization, whereas comorbidities and demographics were evaluated as risk factors. The crude post-hospitalization death rate was 16%. The first 30 days of follow-up had the highest mortality rate. In a Cox regression model for post-hospitalization mortality, previous chronic kidney disease (HR, 4.06, 95%CI 1.46 – 11.30) and longer hospital stay (HR 1.01, 95%CI 1.00 – 1.02) were the only factors statistically associated with death. In conclusion, a high six-month all-cause mortality was observed. Within the six-month follow-up, a higher risk of death was observed for patients who had prior CKD and longer hospital stay. These findings highlight the importance of more intensive medical surveillance during this period.Prevalence and antimicrobial resistance profile of pathogens isolated from patients with urine tract infections admitted to a university hospital in a medium-sized Brazilian city10.1590/S1678-99462024660032024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZNegri, MarianaLima, Bárbara MartinsWoloszynek, Renata dos Santos Batista ReisMolina, Roberto Augusto SilvaGermano, Carla Maria RamosMelo, Débora GusmãoSouza, Leandro Cândido deAvó, Lucimar Retto da Silva de
<em>Negri, Mariana</em>;
<em>Lima, Bárbara Martins</em>;
<em>Woloszynek, Renata Dos Santos Batista Reis</em>;
<em>Molina, Roberto Augusto Silva</em>;
<em>Germano, Carla Maria Ramos</em>;
<em>Melo, Débora Gusmão</em>;
<em>Souza, Leandro Cândido De</em>;
<em>Avó, Lucimar Retto Da Silva De</em>;
<br/><br/>
ABSTRACT This study aimed to determine the antibiotic profile of microorganisms isolated from urine samples of patients with community urine tract infections (UTI) admitted to the University Hospital of the Federal University of Sao Carlos to support an appropriate local empirical treatment. A retrospective cross-sectional study was conducted from October 2018 to October 2020. Data from 1,528 positive urine cultures for bacterial pathogens and antibiograms were tabulated. Bacterial species prevalence and their resistance profile were analyzed and compared by sex and age. For Gram-negative fermenting bacteria, resistance rates were compared between patients with previous hospitalization and the total of infections caused by this group. For comparisons, the Chi-square test was performed, using Fisher’s exact test when necessary (BioEstat program, adopting p ≤ 0.05). A multivariate analysis was applied to assess the effect of the studied variables in predicting multidrug resistance. Infections were more prevalent in women and older adults. Gram-negative bacteria represented 90.44% of total cultures. In both sexes, E. coli prevalence was significantly higher in adults compared with older adults (p < 0.0001). For several antibiotics, resistance rates were higher in the older adults compared with other ages and in patients with Gram-negative fermenting infections and previous hospitalization compared with the total of infections by this group of bacteria. The closer to the hospitalization, the higher the number of antibiotics with superior resistance rates. Resistance rates for aminoglycosides, carbapenems, ceftazidime, nitrofurantoin, piperacillin+tazobactam, and fosfomycin were less than 20%, considered adequate for empirical treatment. Only hospitalization in the previous 90 days was statistically significant in predicting infections by multidrug-resistant bacteria.The decline of measles antibody titers in previously vaccinated adults: a cross-sectional analysis10.1590/S1678-99462024660042024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZCastiñeiras, Anna Carla PintoSales, Amanda CarolinePicone, Camila de MeloDiogo, Constância LimaRossi, Átila DuqueGalliez, Rafael MelloFerreira Jr, Orlando da CostaCastiñeiras, Terezinha Marta Pereira PintoLopes, Marta HeloísaSartori, Ana Marli Christovam
<em>Castiñeiras, Anna Carla Pinto</em>;
<em>Sales, Amanda Caroline</em>;
<em>Picone, Camila De Melo</em>;
<em>Diogo, Constância Lima</em>;
<em>Rossi, Átila Duque</em>;
<em>Galliez, Rafael Mello</em>;
<em>Ferreira Jr, Orlando Da Costa</em>;
<em>Castiñeiras, Terezinha Marta Pereira Pinto</em>;
<em>Lopes, Marta Heloísa</em>;
<em>Sartori, Ana Marli Christovam</em>;
<br/><br/>
ABSTRACT The global reemergence of measles in 2018–2019 reinforces the relevance of high-coverage immunization to maintain the disease elimination. During an outbreak in the Sao Paulo State in 2019, several measles cases were reported in individuals who were adequately vaccinated according to the current immunization schedule recommends. This study aimed to assess measles IgG antibody seropositivity and titers in previously vaccinated adults. A cross-sectional study was conducted at CRIE-HC-FMUSP (Sao Paulo, Brazil) in 2019. It included healthy adults who had received two or more Measles-Mumps-Rubella vaccines (MMR) and excluded individuals with immunocompromising conditions. Measles IgG antibodies were measured and compared by ELISA (Euroimmun®) and chemiluminescence (LIASON®). The association of seropositivity and titers with variables of interest (age, sex, profession, previous measles, number of measles-containing vaccine doses, interval between MMR doses, and time elapsed since the last MMR dose) was analyzed. A total of 162 participants were evaluated, predominantly young (median age 30 years), women (69.8%) and healthcare professionals (61.7%). The median interval between MMR doses was 13.2 years, and the median time since the last dose was 10.4 years. The seropositivity rate was 32.7% by ELISA and 75.3% by CLIA, and a strong positive correlation was found between the tests. Multivariate analyses revealed that age and time since the last dose were independently associated with positivity. Despite being a single-center evaluation, our results suggest that measles seropositivity may be lower than expected in adequately immunized adults. Seropositivity was higher among older individuals and those with a shorter time since the last MMR vaccine dose.<i>In vitro</i> susceptibility to fosfomycin in clinical and environmental extended-spectrum beta-lactamase producing and/or ciprofloxacin-non-susceptible <i>Escherichia coli</i> isolates10.1590/S1678-99462024660052024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZRibeiro, Victoria Stadler TascaBail, LarissaIto, Carmen Antonia SanchesAndrade, Ana Paula deArend, Lavinia Nery Villa StanglerSuss, Paula HansenNogueira, Keite da SilvaWalflor, Haniel Siqueira MortaguaFaoro, HelissonKuczera, Lia Carolina Soares de MedeirosVicenzi, Fernando JoséTuon, Felipe Francisco
<em>Ribeiro, Victoria Stadler Tasca</em>;
<em>Bail, Larissa</em>;
<em>Ito, Carmen Antonia Sanches</em>;
<em>Andrade, Ana Paula De</em>;
<em>Arend, Lavinia Nery Villa Stangler</em>;
<em>Suss, Paula Hansen</em>;
<em>Nogueira, Keite Da Silva</em>;
<em>Walflor, Haniel Siqueira Mortagua</em>;
<em>Faoro, Helisson</em>;
<em>Kuczera, Lia Carolina Soares De Medeiros</em>;
<em>Vicenzi, Fernando José</em>;
<em>Tuon, Felipe Francisco</em>;
<br/><br/>
ABSTRACT Extended-spectrum beta-lactamase producing and ciprofloxacin-non-susceptible Escherichia coli are clinical and environmental issues. We evaluated the susceptibility profile of fosfomycin in non-susceptible E. coli isolated from urine and the environment. We measured the activity of fosfomycin against 319 and 36 E. coli strains from urine and environmental isolates, respectively, collected from rivers. Fosfomycin resistance profiles were investigated using the minimal inhibitory concentration (MIC), according to the Clinical and Laboratory Standards Institute (CLSI) and the European Committee for Antimicrobial Susceptibility Testing (EUCAST) guidelines. Antibiotic susceptibility testing revealed that 5% and 6.6% of urine samples were non-susceptible to fosfomycin according to CLSI and EUCAST guidelines, respectively. The fosfomycin MIC50/90 was 0.5/4 mg/L. Of the 36 E. coli isolates from river water, 11.1% and 13,8% were non-susceptible to fosfomycin according to CLSI and EUCAST, respectively (range ≤0.25 ≥512 mg/L). All the isolates with MIC ≥512 mg/L for fosfomycin showed the fosA3 gene. Fosfomycin resistance was more frequent in the environment than in clinical samples.Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection10.1590/S1678-99462024660072024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZPrates, Gabriela da SilvaMonteiro, Mariana AmeliaOliveira, Éricka ConstantinovNascimento, Najara Ataide de LimaVeiga, Ana Paula RochaFerreira, Mauricio DominguesPolis, Thales José BuenoCaetano, Gabriela PrandiSoares, Beatriz Rodrigues PellegrinaMagri, Marcello Mihailenko ChavesPereira, Luisa OliveiraFonseca, Luiz Augusto MarcondesAlves, Wagner SilvaDuarte, Alberto José da SilvaCasseb, Jorge Simão do Rosário
<em>Prates, Gabriela Da Silva</em>;
<em>Monteiro, Mariana Amelia</em>;
<em>Oliveira, Éricka Constantinov</em>;
<em>Nascimento, Najara Ataide De Lima</em>;
<em>Veiga, Ana Paula Rocha</em>;
<em>Ferreira, Mauricio Domingues</em>;
<em>Polis, Thales José Bueno</em>;
<em>Caetano, Gabriela Prandi</em>;
<em>Soares, Beatriz Rodrigues Pellegrina</em>;
<em>Magri, Marcello Mihailenko Chaves</em>;
<em>Pereira, Luisa Oliveira</em>;
<em>Fonseca, Luiz Augusto Marcondes</em>;
<em>Alves, Wagner Silva</em>;
<em>Duarte, Alberto José Da Silva</em>;
<em>Casseb, Jorge Simão Do Rosário</em>;
<br/><br/>
ABSTRACT Despite being subject to lower AIDS-related mortality rates and having a higher life expectancy, patients with HIV are more prone to develop non-AIDS events. A low CD4+/CD8+ ratio during antiretroviral therapy identifies people with heightened immune senescence and increased risk of mortality. In clinical practice, finding determinants of a low CD4+/CD8+ ratio may be useful for identifying patients who require close monitoring due to an increased risk of comorbidities and death. We performed a prospective study on the evolution of the CD4+/CD8+ ratio in 60 patients infected with HIV (80% males), who were subjected to two different antiretroviral regimens: early and deferred therapy. The initial CD4+/CD8+ ratio was ≤1 for 70% of the patients in both groups. Older age, CD4+ cell count at inclusion, Nadir CD8+T-cell count, and Initial CD4+/CD8+ ratio ≤ 1 were risk factors for lack of ratio recovery. In the multivariate analysis, a CD4+/CD8+ ratio > 1 at the start of the treatment was found to be a determinant factor in maintaining a CD4+/CD8+ ratio > 1. The nadir CD4+T-cell count was lower in the deferred therapy group (p=0.004), and the last CD4+/CD8+ ratio ≤1 was not associated with comorbidities. Ratio recovery was not associated with the duration of HIV infection, time without therapy, or absence of AIDS incidence. A greater improvement was observed in patients treated early (p=0.003). In contrast, the slope of increase was slower in patients who deferred treatment. In conclusion, the increase in the CD4+/CD8+ ratio occurred mostly for patients undergoing early strategy treatment and its extension did not seem to be related to previous HIV-related factors.The influence of growth time on the identification of <i>Bartonella henselae</i> strains by MALDI-TOF mass spectrometry10.1590/S1678-99462024660092024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZLins, Karina de AlmeidaPiveta, Cristiane Santos CruzLevy, Carlos EmilioDrummond, Marina RovaniSantos, Luciene Silva dosSussulini, AlessandraVelho, Paulo Eduardo Neves Ferreira
<em>Lins, Karina De Almeida</em>;
<em>Piveta, Cristiane Santos Cruz</em>;
<em>Levy, Carlos Emilio</em>;
<em>Drummond, Marina Rovani</em>;
<em>Santos, Luciene Silva Dos</em>;
<em>Sussulini, Alessandra</em>;
<em>Velho, Paulo Eduardo Neves Ferreira</em>;
<br/><br/>
ABSTRACT Bartonella spp. are bacteria responsible for neglected diseases worldwide. Bartonella henselae is the species most associated with human infections. It is associated with a large spectrum of clinical manifestations and is potentially fatal. The identification of Bartonella spp. is considered a challenge in clinical routine. These bacteria are fastidious, and the time required to isolate them varies from one to six weeks. MALDI-TOF mass spectrometry has emerged as an application for research on Bartonella spp. , and has still been little explored. We investigated whether three different B. henselae strains with different growth times—14 and 28 days—could be correctly identified by MALDI-TOF mass spectra fingerprint comparison and matching. We found that the spectra from strains with different growth times do not match each other, leading to misidentification. We suggest creating database entries with multiple spectra from strains with different growth times to increase the chances of accurate identification of Bartonella spp. by MALD-TOF MS.Prevalence and clinical consequences of Hepatitis C virus infection in patients undergoing hematopoietic stem cell transplantation10.1590/S1678-99462024660112024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZDiaz, Ana Claudia Marques BarbosaWitkin, Steven SolAlmeida Neto, Cesar deMendrone Junior, AlfredoRocha, VandersonCosta, Silvia FigueiredoRamos, Jessica FernandesMendes-Correa, Maria Cassia
<em>Diaz, Ana Claudia Marques Barbosa</em>;
<em>Witkin, Steven Sol</em>;
<em>Almeida Neto, Cesar De</em>;
<em>Mendrone Junior, Alfredo</em>;
<em>Rocha, Vanderson</em>;
<em>Costa, Silvia Figueiredo</em>;
<em>Ramos, Jessica Fernandes</em>;
<em>Mendes-Correa, Maria Cassia</em>;
<br/><br/>
ABSTRACT Hepatitis C virus (HCV) infection is a significant cause of morbidity and mortality among hematopoietic stem cell transplant (HCT) recipients. In Brazil, its occurrence in HCT recipients remains undetermined. We now report on HCV prevalence in HCT recipients and its clinical consequences. The medical records of all HCT recipients seen at Hospital das Clinicas, Sao Paulo University Medical School, from January 2010 to January 2020 were reviewed to determine HCV serostatus. A retrospective analysis of medical charts was undertaken on all seropositive cases to determine HCV genotype, presence of liver fibrosis, co-infections with other viruses, previous treatments, and clinical evolution of liver pathology after HCT. Of the 1,293 HCT recipients included in the study, seven (0.54%) were HCV antibody-positive and five (0.39%) were also viremic for HCV-RNA. Four of these individuals had moderate to severe liver fibrosis (METAVIR F2/F3) and one was cirrhotic. Two of the viremic patients developed acute liver dysfunction following transplantation. All patients had their acute episode of liver dysfunction resolved with no further complications. Four of the viremic patients were treated for HCV infection with direct acting agents (DAA). Information regarding HCV treatment was lacking for one of the viremic HCV patients due to loss of follow up. Sustained anti-virologic responses were observed in three cases after the use of DAA. The detection of HCV in hematological adults undergoing HCT and its successful treatment with DAA highlight the necessity of testing for HCV both prior to and following transplantation.A spatial case-control study on symptomatic and inapparent primary dengue infections in an endemic city in Brazil10.1590/S1678-99462024660122024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZFigueiredo, GerusaChiaravalloti, FranciscoCampos, SérgioPellini, Alessandra Cristina GuedesFelix, Alvina ClaraLuna, Expedito
<em>Figueiredo, Gerusa</em>;
<em>Chiaravalloti, Francisco</em>;
<em>Campos, Sérgio</em>;
<em>Pellini, Alessandra Cristina Guedes</em>;
<em>Felix, Alvina Clara</em>;
<em>Luna, Expedito</em>;
<br/><br/>
ABSTRACT We conducted a spatial case-control study nested in a dengue incidence cohort to explore the role of the spatial and socioeconomic factors in the proportion of symptomatic (cases) and inapparent primary dengue virus infections (controls). Cohort participants were children and adolescents (2 to 16 years of age) at the beginning of the follow-up. Case definitions were, for symptomatic cases, fever plus a positive lab result for acute dengue (NS1, RT-PCR, ELISA IgM/IgG), and for inapparent infection a positive result for dengue IgG (ELISA) in subjects without symptoms and with a previously negative result at baseline. The covariates included sociodemographic factors, residential location, and socioeconomic context variables of the census tracts of residence of cases and controls. We used principal component analysis to reduce the contextual covariates, with the component values assigned to each one based on their residences. The data were modeled in a Bayesian context, considering the spatial dependence. The final sample consisted of 692 children, 274 cases and 418 controls, from the first year of follow-up (2014-2015). Being male, older age, higher educational level of the head of the family and having a larger number of rooms in the household were associated with a greater chance of presenting dengue symptomatic infection at the individual level. The contextual covariates were not associated with the outcome. Inapparent dengue infection has extensive epidemiological consequences. Relying solely on notifications of symptomatic dengue infections underestimates the number of cases, preserves a silent source of the disease, potentially spreading the virus to unaffected areas.Multiple myeloma and Chagas disease: qPCR as a marker for preemptive antiparasitic therapy: a case reports series and review10.1590/S1678-99462024660102024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZCarvalho, Noemia BarbosaFreitas, Vera Lúcia Teixeira deSeguro, Fernanda SallesBezerra, Rita CristinaFatobene, GiancarloNakanishi, Érika Yoshie ShimodaVisnadi, HelenaMartinez, GraciaBatista, Marjorie VieiraRocha, VandersonDulley, Frederico LuisCosta, Sílvia FigueiredoShikanai-Yasuda, Maria Aparecida
<em>Carvalho, Noemia Barbosa</em>;
<em>Freitas, Vera Lúcia Teixeira De</em>;
<em>Seguro, Fernanda Salles</em>;
<em>Bezerra, Rita Cristina</em>;
<em>Fatobene, Giancarlo</em>;
<em>Nakanishi, Érika Yoshie Shimoda</em>;
<em>Visnadi, Helena</em>;
<em>Martinez, Gracia</em>;
<em>Batista, Marjorie Vieira</em>;
<em>Rocha, Vanderson</em>;
<em>Dulley, Frederico Luis</em>;
<em>Costa, Sílvia Figueiredo</em>;
<em>Shikanai-Yasuda, Maria Aparecida</em>;
<br/><br/>
ABSTRACT Multiple myeloma (MM) associated with Chagas disease is rarely described. This disease and its therapy suppress T cell and macrophage functions and increase regulatory T cell function, allowing the increase of parasitemia and the risk of Chagas Disease Reactivation (CDR). We aimed to analyze the role of conventional (cPCR) and quantitative Polymerase Chain Reaction (qPCR) for prospective monitoring of T. cruzi parasitemia, searching for markers of preemptive antiparasitic therapy in MM patients with Chagas disease. Moreover, we investigated the incidence and management of hematological diseases and CDR both inside and outside the transplant setting in the MEDLINE database. We found 293 studies and included 31 of them. Around 1.9–2.0% of patients with Chagas disease were reported in patients undergoing Stem Cell Transplantation. One case of CDR was described in eight cases of MM and Chagas disease. We monitored nine MM and Chagas disease patients, seven under Autologous Stem Cell Transplantation (ASCT), during 44.56±32.10 months (mean±SD) using parasitological methods, cPCR, and qPCR. From these patients, three had parasitemia. In the first, up to 256 par Eq/mL were detected, starting from 28 months after ASCT. The second patient dropped out and died soon after the detection of 161.0 par Eq/mL. The third patient had a positive blood culture. Benznidazole induced fast negativity in two cases; followed by notably lower levels in one of them. Increased T. cruzi parasitemia was related to the severity of the underlying disease. We recommend parasitemia monitoring by qPCR for early introduction of preemptive antiparasitic therapy to avoid CDR.Severe esophagitis induced by antituberculosis drugs: a case report10.1590/S1678-99462024660022024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZMamani, Roxana FloresSilva, Franciele MoreiraLima-Júnior, Marcos Vidal deLima, Juliana Paitach de OliveiraVianna, Vitor MontezAzevedo, Rivelino Trindade deMcBenedict, BillyMartins, Ezequias Batista
<em>Mamani, Roxana Flores</em>;
<em>Silva, Franciele Moreira</em>;
<em>Lima-Júnior, Marcos Vidal De</em>;
<em>Lima, Juliana Paitach De Oliveira</em>;
<em>Vianna, Vitor Montez</em>;
<em>Azevedo, Rivelino Trindade De</em>;
<em>Mcbenedict, Billy</em>;
<em>Martins, Ezequias Batista</em>;
<br/><br/>
ABSTRACT Tuberculosis stands as one of humanity’s oldest afflictions, intrinsically intertwined with social disparities. This formidable disease spares no age group and remains the prevailing cause of infection-induced mortality worldwide, particularly in developing nations. We present a case of a 56-year-old woman with diabetes who was diagnosed with Pulmonary Tuberculosis. After receiving antituberculosis drugs as part of her treatment, she experienced a range of systemic manifestations and suffered from severe ulcerative esophagitis. This adverse reaction led to uncontrollable gastrointestinal intolerance, tragically resulting in her untimely demise. The incident underscores the potential seriousness of adverse reactions that can arise from tuberculosis treatment medications.Secondary oral syphilis presenting as a tumor-like lesion on the lower lip10.1590/S1678-99462024660062024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZSugaya, NorbertoMigliari, Dante
<em>Sugaya, Norberto</em>;
<em>Migliari, Dante</em>;
<br/><br/>
ABSTRACT This study presents a case of atypical manifestation of secondary syphilis. Diagnosis was initiated prompted by the patient’s complaint of a lower lip lesion, present for three months, resembling a malignant neoplasm. The lesion, a 3 cm (diameter) ulcerated nodule, arising from conjunctive tissue, raised concern. However, further physical examination revealed additional clinical features, including cervical micropolyadenopathy and erythematous skin lesions, prompting a reevaluation of the diagnosis, most likely secondary syphilis. These findings led to a serological investigation, which, ultimately, confirmed the diagnosis of syphilis. The case underscores the importance of recognizing syphilis as a formidable imitator, posing challenges in establishing differential diagnoses of mucocutaneous diseases.Calcified cerebral toxoplasmosis associated with recurrent perilesional edema causing neurological manifestations in an HIV-infected individual: case report with a decade-long follow-up10.1590/S1678-99462024660152024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZBonato, Flávia Carolina SoaresRivero, René Leandro MagalhãesGarcia, Hector HugoVidal, José Ernesto
<em>Bonato, Flávia Carolina Soares</em>;
<em>Rivero, René Leandro Magalhães</em>;
<em>Garcia, Hector Hugo</em>;
<em>Vidal, José Ernesto</em>;
<br/><br/>
ABSTRACT Four cases of people living with HIV/AIDS (PLWHA) with calcified cerebral toxoplasmosis associated with perilesional edema causing a single episode of neurological manifestations have recently been reported. Here, we describe the first detailed description of perilesional edema associated with calcified cerebral toxoplasmosis causing three episodes of neurological manifestations in a PLWHA, including seizures in two of them. These recurrences occurred over approximately a decade. Throughout this period, the patient showed immunological and virological control of the HIV infection, while using antiretroviral therapy regularly. This case broadens the spectrum of an emerging presentation of calcified cerebral toxoplasmosis, mimicking a well-described finding of neurocysticercosis in immunocompetent hosts.Neurological manifestation of Brazilian spotted fever in childhood10.1590/S1678-99462024660162024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZMendes, Bruna Fernanda DeickeMoreira, Marina MeloJimenez, Ana Luisa LodiSilva, Lívia Barbosa daThiersch, Laura Maria SilvaRodrigues, Carolina MalaquiasTorres, Bruna RibeiroCosta, Juliana Goulart Dias daDiniz, Lilian Martins Oliveira
<em>Mendes, Bruna Fernanda Deicke</em>;
<em>Moreira, Marina Melo</em>;
<em>Jimenez, Ana Luisa Lodi</em>;
<em>Silva, Lívia Barbosa Da</em>;
<em>Thiersch, Laura Maria Silva</em>;
<em>Rodrigues, Carolina Malaquias</em>;
<em>Torres, Bruna Ribeiro</em>;
<em>Costa, Juliana Goulart Dias Da</em>;
<em>Diniz, Lilian Martins Oliveira</em>;
<br/><br/>
ABSTRACT Rocky Mountain Spotted Fever is a rickettsial disease caused by the bacteria Rickettsia rickettsii. In Brazil, the disease is known as Brazilian spotted fever (BSF), being the most significant tick-borne disease in the country. Among the affected patients, only 5% of cases occur in children aged one to nine years. Typical symptoms of the disease are fever, rash, headache and digestive symptoms. Neurological manifestations such as seizures, aphasia and hemiparesis have been described in few patients. This study aimed to describe the case of an infant diagnosed with BSF who presented severe signs of neurological manifestation.Myelotoxicity and kidney dysfunction related to the use of trimethoprim-sulfamethoxazole for the treatment of <i>Pneumocystis jirovecii</i> pneumonia: a case report of severe adverse events with a common drug10.1590/S1678-99462024660182024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZMendes, Isabel Cristina MeloMamani, Roxana FloresCoelho, David Richer AraujoPimentel, Clarisse
<em>Mendes, Isabel Cristina Melo</em>;
<em>Mamani, Roxana Flores</em>;
<em>Coelho, David Richer Araujo</em>;
<em>Pimentel, Clarisse</em>;
<br/><br/>
ABSTRACT Trimethoprim-sulfamethoxazole (TMP-SMX) is the primary therapeutic option for Pneumocystis jirovecii pneumonia (PCP). Gastrointestinal symptoms and cutaneous rash are common side effects, with hyperkalemia being uncommon in patients without kidney dysfunction, and myelotoxicity being even rarer. We present the case of a male patient with hypertension and a recent diagnosis of non-Hodgkin lymphoma, undergoing rituximab treatment for two months. He was admitted to the intensive care unit due to dyspnea, tachypnea, and pleuritic pain, requiring mechanical ventilation. Chest computed tomography showed bilateral and multilobed ground-glass opacities, compromising more than 80% of the lung parenchyma. Pulmonary tuberculosis and COVID-19 were ruled out. An angiotomography and Doppler ultrasound revealed an extensive pulmonary thrombus and deep venous thrombosis. Empiric treatment with TMP-SMX for PCP was initiated, but within four days, the patient experienced metabolic acidosis and severe hyperkalemia, necessitating hemodialysis. He also presented with progressive pancytopenia and critical levels of leukopenia and thrombocytopenia. The hypothesis of TMP-SMX-induced myelotoxicity was suspected. Considering the unavailability of an alternative treatment, it was opted to continue TMP-SMX and initiate a granulocyte-colony-stimulating factor. However, the patient maintained medullary deterioration, becoming refractory to the transfusion of blood derivates. On the 17th day of treatment, a clinical decision was made to suspend TMP-SMX, leading to improvements within 48 hours in marrow and kidney functions, metabolic acidosis, and hyperkalemia. Despite all efforts, the patient died after 35 days of hospitalization due to hospital-acquired infections. This case highlights the importance of clinicians recognizing potential myelotoxicity with TMP-SMX and promptly discontinuing the drug if necessary.Identification of SARS-CoV-2 in urban rodents from Southern Mexico City at the beginning of the COVID-19 pandemic10.1590/S1678-99462024660082024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZMartínez-Hernández, FernandoGonzalez-Arenas, Nelly RaquelCervantes, José Antonio OcampoVillalobos, GuiehdaniOlivo-Diaz, AngelicaRendon-Franco, EmilioMaravilla, PabloValdovinos, Mirza RomeroMuñoz-Garcia, Claudia Irais
<em>Martínez-Hernández, Fernando</em>;
<em>Gonzalez-Arenas, Nelly Raquel</em>;
<em>Cervantes, José Antonio Ocampo</em>;
<em>Villalobos, Guiehdani</em>;
<em>Olivo-Diaz, Angelica</em>;
<em>Rendon-Franco, Emilio</em>;
<em>Maravilla, Pablo</em>;
<em>Valdovinos, Mirza Romero</em>;
<em>Muñoz-Garcia, Claudia Irais</em>;
<br/><br/>
ABSTRACT Currently, there are some concerns about the situation and, in particular, about the future of the COVID-19 pandemic and the new emerging variants of SARS-CoV-2. Rodents are an example of synanthropic animals in urban environments that harbor important zoonoses. Although the molecular identification of SARS-CoV-2 in Rattus norvegicus from New York City had been reported, in other studies, urban wild rodents infected with this virus have not been found. This study aimed to molecularly identify the presence of SARS-CoV-2 in urban wild rodents from Mexico City, trapped along a water channel of a public park as part of a pest control program, at the beginning of the COVID-19 pandemic, during the fall and winter of 2020. Up to 33 Mus musculus and 52 R. norvegicus were captured and euthanized, large intestine samples with feces from the animals were obtained. RNAs were obtained and subjected to qRT-PCR for SARS-CoV-2 identification and threshold cycle (Ct) values were obtained. Four mice (12.1%) and three rats (5.8%) were positive, three rodents exhibited Ct<30. Our results on the frequency of SARS-CoV-2 in urban rats are in line with other previous reports. Thus, similar to other authors, we suggest that surveillance for the detection of SARS-CoV-2 in urban wild rodents, as sentinel animals, should be maintained.Viable <i>Leishmania</i> parasites in the absence of an <i>in vitro</i> IFN-γ response in asymptomatic carriers10.1590/S1678-99462024660132024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZLoría-Cervera, Elsy NalleliSosa-Bibiano, Erika IvettLópez-Ávila, Karina BeatrizOca-Aguilar, Ana Celia Montes deMoreno-Nava, Marisol SarahíTorres-Castro, Jimmy Raymundo
<em>Loría-Cervera, Elsy Nalleli</em>;
<em>Sosa-Bibiano, Erika Ivett</em>;
<em>López-Ávila, Karina Beatriz</em>;
<em>Oca-Aguilar, Ana Celia Montes De</em>;
<em>Moreno-Nava, Marisol Sarahí</em>;
<em>Torres-Castro, Jimmy Raymundo</em>;
<br/><br/>
ABSTRACT Asymptomatic infection (the absence or inapparent signs and symptoms) has been observed in many endemic areas of leishmaniasis, however, little is known about the parasitological and immunological factors associated with this type of infection. This study aimed to identify the in vitro expression of IFN-γ in asymptomatic carriers of viable Leishmania parasites. Asymptomatic infection was identified using the Montenegro skin test in an at-risk population from Yucatan, Mexico. Parasite viability was evinced in the blood by 7SL RNA transcripts amplification. The expression of mRNA IFN-γ was analyzed in peripheral blood mononuclear cells stimulated with soluble Leishmania antigen, using RT-qPCR. Parasite viability was observed in 33.3 % (5/15) of asymptomatic subjects. No differences were found in the expression of IFN-γ between asymptomatic and healthy subjects, and no correlation was found between the presence of viable parasites and the expression of IFN-γ. This study demonstrates the persistence of Leishmania parasites in the absence of an in vitro IFN-γ response in asymptomatic carriers from Mexico.Cardiorespiratory optimal point in post-COVID-19 patients: a cross-sectional study10.1590/S1678-99462024660142024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZSantos, Karinne Simões da CruzBrito, Gabriela Menezes Gonçalves deMelo, Enaldo Vieira deSousa, Antônio Carlos SobralMartins-Filho, Paulo RicardoCampos, Milena dos Santos Barros
<em>Santos, Karinne Simões Da Cruz</em>;
<em>Brito, Gabriela Menezes Gonçalves De</em>;
<em>Melo, Enaldo Vieira De</em>;
<em>Sousa, Antônio Carlos Sobral</em>;
<em>Martins-Filho, Paulo Ricardo</em>;
<em>Campos, Milena Dos Santos Barros</em>;
<br/><br/>
ABSTRACT The varied clinical presentations of SARS-CoV-2 infection have raised concerns about long-term consequences, especially “long-COVID” or “post-COVID-19 syndrome.” In this context, the cardiorespiratory optimal point (COP) within the Cardiopulmonary Exercise Test (CPET) emerges as a crucial metric for evaluating functional capacities and detecting cardiovascular and pulmonary anomalies post-COVID-19. This study aimed to assess COP values among post-COVID-19 patients and categorized them based on the initial severity of their disease. In this cross-sectional study conducted in the Northeast Brazil, 80 patients (26 females and 54 males) previously infected with SARS-CoV-2 underwent CPET. We clinically stratified patients into mild, moderate, or severe COVID-19 categories and assessed COP values and other cardiorespiratory metrics. We found differences in the predicted COP between patients with mild and severe COVID-19 (p=0.042). Additionally, patients with moderate and severe COVID-19 record had an average COP value exceeding 22. Other parameters, including respiratory exchange ratio, heart rate, and oxygen uptake efficiency slope, did not differ across the groups. Patients with a history of severe COVID-19 showed altered COP values, suggesting potential discrepancies in cardiovascular and respiratory system integration. The outcomes emphasize the importance of continuous monitoring and assessment of the cardiorespiratory domain for post-COVID-19 patients. Further research is needed to understand the relationship between elevated COP in post-severe COVID-19 and its long-term prognostic implications.COVID-19 in hematopoietic stem cell transplant recipients during three years of the pandemic: a multicenter study in Brazil10.1590/S1678-99462024660172024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZRandi, Bruno AzevedoHigashino, Hermes RyoitiSilva, Vinícius Ponzio daSalomão, Matias ChiarastelliPignatari, Antonio Carlos CamposAbdala, EdsonVasques, FabianaSilva, Celso Arrais Rodrigues daSilva, Roberto Luiz daLazari, Carolina dos SantosLevi, José EduardoXavier, Erick MenezesCôrtes, Marina FarrelLuna-Muschi, AlessandraRocha, VandersonCosta, Silvia Figueiredo
<em>Randi, Bruno Azevedo</em>;
<em>Higashino, Hermes Ryoiti</em>;
<em>Silva, Vinícius Ponzio Da</em>;
<em>Salomão, Matias Chiarastelli</em>;
<em>Pignatari, Antonio Carlos Campos</em>;
<em>Abdala, Edson</em>;
<em>Vasques, Fabiana</em>;
<em>Silva, Celso Arrais Rodrigues Da</em>;
<em>Silva, Roberto Luiz Da</em>;
<em>Lazari, Carolina Dos Santos</em>;
<em>Levi, José Eduardo</em>;
<em>Xavier, Erick Menezes</em>;
<em>Côrtes, Marina Farrel</em>;
<em>Luna-Muschi, Alessandra</em>;
<em>Rocha, Vanderson</em>;
<em>Costa, Silvia Figueiredo</em>;
<br/><br/>
ABSTRACT Hematopoietic stem cell transplant (HSCT) recipients are at -increased risk for severe COVID-19. The aim of this study was to evaluate the burden of COVID-19 in a cohort of HSCT recipients. This retrospective study evaluated a cohort of adult hospitalized HSCT recipients diagnosed with COVID-19 in two large hospitals in São Paulo, Brazil post-HSCT, from January 2020 to June 2022. The primary outcome was all-cause mortality. Of 49 cases, 63.2% were male with a median age of 47 years. Allogeneic-HSCT (51.2%) and autologous-HSCT (48.9%) patients were included. The median time from HSCT to COVID-19 diagnosis was 398 days (IQR: 1211-134), with 22 (44.8%) cases occurring within 12 months of transplantation. Most cases occurred during the first year of the pandemic, in non-vaccinated patients (n=35; 71.4%). Most patients developed severe (24.4%) or critical (40.8%) disease; 67.3% received some medication for COVID-19, primarily corticosteroids (53.0%). The probable invasive aspergillosis prevalence was 10.2%. All-cause mortality was 40.8%, 51.4% in non-vaccinated patients and 14.2% in patients who received at least one dose of the vaccine. In the multiple regression analyses, the variables mechanical ventilation (OR: 101.01; 95% CI: 8.205 – 1,242.93; p = 0.003) and chest CT involvement at diagnosis ≥50% (OR: 26.61; 95% CI: 1.06 – 664.26; p = 0.04) remained associated with all-cause mortality. Thus, HSCT recipients with COVID-19 experienced high mortality, highlighting the need for full vaccination and infection prevention measures.Evaluation of larval surface antigens from infective larvae of <i>Strongyloides venezuelensis</i> for the serodiagnosis of human strongyloidiasis10.1590/S1678-9946202466001err2024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000ZCan COVID-19 impact the natural history of paracoccidioidomycosis? Insights from an atypical chronic form of the mycosis10.1590/S1678-9946202466057err2024-01-02T20:27:02.011000Z2020-08-09T06:49:20.912000Z