Neurossífilis gomatosa. Relato de caso / Intracranial syphilitic gummata. Case report

Os autores relatam um caso de goma neurossifilítica. Esta entidade patológica é muito rara em nosso meio, mas novos casos vêm surgindo desde o surgimento da síndrome da imunodeficiência adquirida humana, contrapondo-se à tendência observada com o advento da penicilinoterapia. A neurossífilis gomatosa é uma das seis manifestações da sífilis terciária envolvendo o sistema nervoso central, incluindo, além da goma, a neurossífilis assintomática, a meningite sifilítica sintomática aguda, a meningovasculite, a neurossífilis parenquimatosa (tabes dorsalis) e a neurossífilis congênita. Os sinais e os sintomas são similares às lesões expansivas intracranianas e, neste caso em particular, o diagnóstico diferencial com tuberculoma se faz necessário, em razão da grande prevalência de tuberculose em nosso meio. O objetivo do relato deste caso peculiar é reforçar a admissão dessa enfermidade no diagnóstico diferencial das lesões expansivas intracranianas, já que o diagnóstico por imagem é inconclusivo. Somente o exame anatomopatológico, que demonstra grandes áreas de necrose e infiltrado inflamatório granulomatoso, acrescido de exames sorológicos para sífilis, testes não-treponêmicos e testes treponêmicos, poderá estabelecer o diagnóstico definitivo.

Three year seroepidemiological study of varicella-zoster virus in São Paulo, Brazil

A serosurvey of varicella has been carried out in children attending the public school network of São Paulo city, Brazil, from 1992 to 1994. This study was performed in order to establish the age related prevalence of antibodies against varicella-zoster virus (VZV) and its age specific transmission dynamics pattern in these children. Among 2500 schools in the city of São Paulo public network, 304 were randomly selected; 7 children of a given age (ranging from 1 to 15 years) were randomly selected in each school, and blood samples were obtained by fingerprick into filter paper. Blood eluates were analyzed for the presence of antibodies to VZV by ELISA. Proportion of seropositivity were calculated for each age group. Samples consisted of 1768 individuals in 1992, 1758 in 1993, and 1817 in 1994, resulting in 5343 eluates. A high proportion of seropositive children from 1 to 3 years of age was observed, ascending until 10 years of age and reaching a plateau around 90 percent afterwards. VZV transmission in this community was similar along the three years of the study. In children attending public schools in the city of São Paulo, contact with VZV occurs in early childhood. If immunization against VZV is considered it should be introduced as soon as possible.

Meningite criptocócica em pacientes imunocompetentes: relato de dois casos e revisäo da literatura / Cryptococcal meningitis in immunocompetent patients: report of two cases and literature review

A criptococose é uma doença sistêmica causada pelo fungo Cryptococcus neoformans, que acomete com mais freqüência os pulmões e o sistema nervoso central e, menos freqüentemente, a pele, o sistema esquelético e a próstata. Até a década de 80, antes do surgimento da AIDS, era relativamente rara. Apesar dela ocorrer com freqüência no hospedeiro imunodeprimido, cerca de um terço dos pacientes com a doença näo apresenta uma condiçäo de base, nem fatores predisponentes evidentes. Relatamos dois casos de pacientes imunocompetentes que apresentaram meningite criptocócica, enfatizando epidemiologia, etiopatogenia, clínica, diagnóstico e conduta terapêutica

Hepatitis B vaccination of heath care workers is not yet a reality

It is well documented that health care workers (HCW) have a higher prevalence of hepatitis B markers, and a higher risk of acquiring hepatitis than the general population does. In this study, we obtained the prevalence of vaccination against hepatitis B among HCW in a tertiary hospital, evaluated the reasons why hospital personnel did not use the vaccine, and we determined the prevalence of accidents which carried the potential of infection among the professional staff. HCW at possible risk were included in the study. The investigation showed that 39.3 percent of HCW were completely vaccinated, 12.9 percent received only partial vaccination, 8.4 percent were in the process of a vaccination series, 36.5 percent were never vaccinated, and 2.8 percent had passive immunization against hepatitis B virus. Lack of opportunity and difficulty in obtaining the vaccine were the main reasons given for non-vaccination. Of the non-vaccinated, 84.5 percent declared an intention to take the vaccine. Accidents with a potential for infection were observed in 57.9 percent of the population (sharp object accidents in 48.6 percent, accidents involving contact with blood or body fluids on mucous membranes in 27.6 percent and incision related accidents in 5.3 percent). The accidents were grouped into categories of risk of infection according to profission or medical speciality. Surgeons had the highest number of accidents. Strategies for vaccination campaign plans include an emphasis on the risks of exposure to the virus, discussion about the efficacy and safety of vaccination, and counselling to eliminate reistence to immunization.

Comprometimento pulmonar na malária (revisão) / Pulmonary involvement in malaria (review)

Pulmonary involvement occurs in 3 to 10 of the cases of Plasmodium falciparum malaria and represents the most serious complication of this infection, with a lethality of about 70. The understanding of its pathogenesis is still very fragmentary, however it is recognized that activation of the immune system by antigens released by the parasite plays an important role in the induction and worsening of lung damage. Capillary endothelial cells, which control the flux of fluids to the interstitial space, appear to be the most involved structure. These cells are activated by cytokines, produced by lymphocytes and macrophages during the immune response, and express receptors and molecules of adhesion, allowing for sequestration of parasitized erythrocytes and adherence of cells, which will produce locally inflammatory mediators. The inflammatory reaction and lesion of endothelial cells that ensue, together with the hemodynamic alterations induced by the capillary blockade due to the sequestration of parasitized erythrocytes and leukocytes, cause alterations of the vascular permeability and transfer of liquid to intertitial space and alveoles. Severe cases are clinically expressed by a picture of Adult Respiratory Distress Syndrome. The clinical manifestations of pulmonary involvement may start suddenly at any time during the course of malaria, even after disappearance of circulating parasites. The inducing factors are unknown. Hyperparasitemia, renal failure and pregnancy are predisposing factors. The prognosis will depend on how fast the diagnosis is established and convenient treatment initiated. If parasites are present they shall be treated with schizonticidal drugs, hemodynamic parameters continuously evaluated, preferably through a Swam-Ganz catheter. Appropriate oxygen supply and fluid balance have to be warranted. Other complications of malaria, frequently associated to the pulmonary involvement, need special attention and proper treatment. A better understanding of the pathogenesis of lung damage associated to malaria will certainly help to improve treatment and reduce morbidity and mortality.