COVID-19 na doença inflamatória intestinal: devemos ser mais cautelosos com o uso dos salicilatos? / Covid-19 in inflammatory bowel disease: should we be more careful with the use of salicylates?

ABSTRACT Backgrounds: Fortunately, much has been studied about COVID-19 in patients with inflammatory bowel diseases (IBD). Evidence suggests that these patients do not appear to be at increased risk of severe COVID-19. However, there are still some uncertainties regarding the clinical manifestations of COVID-19 in patients with immune-mediated diseases. Objective: This study aimed to describe the main symptoms of COVID-19 and their frequency in IBD patients and evaluate the impact of the IBD therapeutic drugs on clinical presentation of COVID-19 and to determine factors associated with COVID-19 in this population. Methods: Adult patients with IBD from three tertiary-care public, teaching hospitals in Ceará, Northeastern Brazil, were evaluated during one scheduled appointment from March to December 2020. Patients with possible or confirmed COVID-19 were compared with patients without COVID-19. Furthermore, incidences of each symptom were evaluated based on the use of IBD therapeutic drugs. Results: A total of 515 patients with IBD were included in the study: 234 with CD, and 281 with UC. Of these, 174 patients (34%) had possible/confirmed COVID-19 of whom 156 (90%) were symptomatic. Main symptoms were fever (65%) and headache (65%); gastrointestinal symptoms occurred in one third of patients and were higher than COVID-19 in general population. The factors associated with having COVID-19 were female gender (OR 1.71, 95%CI: 1.17-2.50); contact at home (OR 5.07, 95%CI: 3.31-7.78) and outside the home (OR 3.14, 95%CI: 2.10-4.71) with a case of COVID-19; work outside of the home (OR 1.87, 95%CI: 1.26-2.78); family history of COVID-19 (OR 2.29, 95%CI 1.58-3.33) use of salicylate (OR 1.71, 95%CI: 1.17-4.28); and asthma (OR 7.10, 95%CI: 1.46-34.57). Conclusion: IBD patients at high risk of COVID-19 infection may need to avoid salicylate therapy but further studies are necessary to confirm this association.

RESUMO Contexto: Felizmente, muito se tem estudado sobre a COVID-19 em pacientes com doenças inflamatórias intestinais (DII). As evidências sugerem que esses pacientes não parecem ter risco aumentado de COVID-19 grave. Mas ainda se tem algumas incertezas com relação às manifestações clínicas da COVID-19 em portadores de doenças imunomediadas. Objetivo: Este estudo teve como objetivo descrever os principais sintomas da COVID-19 e sua frequência em pacientes com DII e avaliar o impacto dos medicamentos utilizados no tratamento das DII na apresentação clínica da COVID-19. Métodos: Pacientes adultos com DII de três hospitais públicos terciários de ensino do Ceará, Nordeste do Brasil, foram avaliados em consulta ambulatorial no período de março a dezembro de 2020. Pacientes com COVID-19 possível ou confirmada foram comparados com pacientes sem COVID-19. Além disso, as incidências de cada sintoma foram avaliadas com base no uso de medicamentos utilizados para tratamento da DII. Resultados: Foram incluídos no estudo 515 pacientes com DII: 234 com DC e 281 com RCU. Destes, 174 pacientes (34%) tinham COVID-19 possível/confirmado, dos quais 156 (90%) eram sintomáticos. Os principais sintomas foram febre (65%) e dor de cabeça (65%); sintomas gastrointestinais ocorreram em um terço dos pacientes, sendo mais frequentes do que na população geral com COVID-19. Os fatores associados a ter COVID-19 foram sexo feminino (OR 1,71, IC95%: 1,17-2,50); ter contato com caso de COVID-19, tanto intradomiciliar (OR 5,07; IC95%: 3,31-7,78) como fora do domicílio (OR 3,14; IC95%: 2,10-4,71); trabalhar fora de casa (OR 1,87; IC95%: 1,26-2,78); história familiar de COVID-19 (OR 2,29, IC95% 1,58-3,33), uso de salicilato (OR 1,71, IC95%: 1,17-4,28) e asma (OR 7,10; IC95%: 1,46-34,57). Conclusão: Pacientes com DII com alto risco de infecção por COVID-19 podem precisar evitar a terapia com salicilatos, mas mais estudos são necessários para confirmar esta associação.

Streptococcus equi subspecies zooepidemicus: an emergent cause of meningoencephalitis in Northeastern Brazil

ABSTRACT This study describes an outbreak of Streptococcus equi subspecies zooepidemicus infections that caused meningoencephalitis and bacteremia related to unpasteurized milk consumption in northeastern Brazil. Epidemiological investigations and a brief literature review were conducted. Strains with possible neurotropism had not been identified in Brazil before these cases; however, in 2023, another case of meningoencephalitis caused by Streptococcus equi sp. zooepidemicus was described, revealing the need to maintain surveillance and highlighting that these neurotropic strains continue to circulate in the environment.

Human Rabies during the COVID-19 Pandemic: Insights into Rabies Worldwide and Brazil

ABSTRACT Human Rabies (HR) is a fatal zoonotic disease caused by lyssaviruses, with the rabies virus (RABV) identified as the causative agent. While the incidence of HR transmitted by dogs has decreased in Latin America, there has been a corresponding rise in transmission via wild animals. Given the lack of effective treatments and specific therapies, the management of HR relies on the availability of post-exposure prophylaxis and animal control measures. This review examines the dynamics and spread of HR during the global pandemic.

Infectious endocarditis due to Bacillus Cereus in a patient with a pacemaker: case report and literature review / Endocardite infecciosa por Bacillus Cereus em paciente portador de marcapasso: relato de caso e revisão de literatura

Introduction: Infective endocarditis (IE) is an infectious process of the cardiac endothelium, often related to the use of pacemakers and valve prostheses, which may facilitate microorganism" proliferation. Case Report: In this article, we describe the case of an 81-year-old man with infective endocarditis due to Bacillus Cereus related to the use of a pacemaker and perform a brief literature review. Discussion: Bacillus Cereus is a Gram-positive, aerobic, spore-forming, large, and generally motile bacterium that constitutes a rare cause of endocarditis, but few cases like this are described in the literature. Conclusion: Determining the etiology of IE through culture-guided methods plays a pivotal role in selecting appropriate antibiotic treatment. Maintain a high clinical suspicion for IE is paramount, especially when fever arises in patients with cardiac devices after surgical or dental procedures.

Introdução: A endocardite infecciosa é um processo infeccioso do endotélio cardíaco, muitas vezes relacionado ao uso de marca-passos e próteses valvares, que pode facilitar a proliferação de microrganismos. Relato de Caso: Neste artigo descrevemos o caso de um homem de 81 anos com endocardite infecciosa por Bacillus Cereus relacionada ao uso de marca-passo e realizamos uma breve revisão da literatura. Discussão: Bacillus Cereus é uma bactéria Gram-positiva, aeróbia, formadora de esporos, grande e geralmente móvel, que constitui uma causa rara de endocardite, com poucos casos descritos na literatura. Conclusão: A determinação da etiologia da EI através de métodos guiados por cultura desempenha um papel fundamental na seleção do tratamento antibiótico apropriado. Manter alta suspeita clínica de EI é fundamental, principalmente quando surge febre em pacientes portadores de dispositivos cardíacos após procedimentos cirúrgicos ou odontológicos.

Severe mpox in patients with advanced AIDS: long-term disease and fatal outcome

ABSTRACT Herein, we report two cases of severe mpox in patients with advanced acquired immunodeficiency syndrome from Brazil who developed atypical lesions and prolonged illness, one of whom had a fatal outcome. Both patients experienced serious complications involving the perianal and genital regions and prolonged disease with persistent viremia.

Streptococcus constellatus causing concomitant extra and intracranial abscesses complicated with sagittal sinus thrombosis

ABSTRACT Streptococcus constellatus is a gram-positive coccus member of the Streptococcus anginosus group (SAG). It can be found in the oral flora, and may cause abscess more commonly in the gastrointestinal tract, lungs, and heart. Brain abscesses are severe neurological infections with high mortality rates. Streptococcus species other than S. pneumoniae are rare causes of brain abscesses. This case report highlights a severe case of extra and intracranial abscesses due to S. constellatus in an immunocompetent host

A fatal case of COVID-19-associated meningoencephalitis in a patient coinfected with influenza A

ABSTRACT We report a case of COVID-19-associated meningoencephalitis with a fatal outcome in a male patient with concomitant influenza A, who had been hospitalized at the beginning of 2022, in the Northeastern region of Brazil. He died due to cardiopulmonary arrest after developing status epilepticus on the third day of hospitalization. The SARS-CoV-2 RNA was detected in cerebrospinal fluid and Influenza A was detected in the nasopharyngeal swab. Meningoencephalitis due to COVID-19 is a rare manifestation and physicians must be aware of this complication, mainly during the pandemic. In viral co-circulation situations, the possibility of respiratory coinfections should be remembered.

COVID-19-associated meningoencephalitis in a Brazilian patient: case report and literature review

ABSTRACT The global pandemic of COVID-19 is caused by the novel coronavirus SARS-CoV-2, which often causes flu-like symptoms and can progress to severe respiratory illness. Thus, as the disease spreads, COVID-19 cases have multiplied across the world, and manifestations involving multiple systems have been described. We report a case of COVID-19-associated meningoencephalitis in a Brazilian male patient who presented with seizures and altered mental status. To the best of our knowledge, this is the first reported case of COVID-19-associated meningoencephalitis in Brazil. COVID-19-associated meningoencephalitis is a rare manifestation of this viral infection and clinicians should be aware of this possible complication.

Meningitis caused by Capnocytophaga canimorsus in a COVID-19 patient: a rare complication of dog bites

ABSTRACT Capnocytophaga canimorsus is a gram-negative rod that is part of the commensal microbiota of dogs' and cats' mouths. In this case, we report an 85-year-old man with COVID-19 who had his right arm bitten by a dog. His symptoms were impaired consciousness, agitation and aggressive behavior. Physical examination revealed neck stiffness and Brudzinski's sign. The cerebrospinal fluid culture was compatible with Capnocytophaga canimorsus. He required intensive care and received a 14-day prescription of meropenem. After 40 days of hospitalization, the patient was fully recovered and was discharged. This case highlights the importance of physician and microbiologist be awareness of this disease, mainly in patients with neurological symptoms after a dog or cat bite.

Rhino-orbital mucormycosis in a diabetes patient with renal impairment after amphotericin B deoxycholate: the role of amphotericin B lipid-complex treatment / Mucormicose rino-orbital em um paciente com diabetes e insuficiência renal após desoxicolato de anfotericina B deoxicolato: o papel do tratamento com anfotericina B complexo-lipídico

Introduction: Mucormycosis is an infection caused by the ubiquitous saprophyte fungi with rapid and aggressive progression, especially in immunocompromised patients. Case report: A 57-year-old woman diagnosed with rhino-orbital mucormycosis presented with decreased renal function after treatment with amphotericin B deoxycholate which was discontinued. Renal function improved after amphotericin B lipid-complex, being also treated with itraconazole, and otorhinolaryngological surgery. Conclusion: The use of Amphotericin B deoxycholate may result in adverse effects. In this situation, Amphotericin B lipid formulation is usually the drug of choice.

Introdução: A mucormicose é uma infecção causada por fungos saprófitos com progressão rápida e agressiva, principalmente em pacientes imunocomprometidos. Relato de caso: Uma paciente de 57 anos, do sexo feminine, com diagnóstico de mucormicose rinorbital apresentou diminuição da função renal após tratamento com anfotericina B desoxicolato que foi descontinuada. A função renal foi recuperada após troca da terapia por anfotericina B complexo lipídico, sendo tratada também com itraconazol e cirurgia otorrinolaringológica. Conclusão: O uso de anfotericina B desoxicolato pode resultar em efeitos adversos. Nestas situações a formulação lipídica da anfotericina B é geralmente a droga de escolha.

Systemic inflammatory syndrome in children during COVID-19 pandemic in Ceará state, northeastern Brazil: an observational study

Abstract In this study, we report the occurrence of multisystemic inflammatory syndrome among 64 children (2 deaths) with recent severe acute respiratory syndrome-related coronavirus 2 (SARS-COV-2) infections in the northeast region of Brazil. The major clinical symptoms and signs reported were exanthema (60.9%), abdominal pain (56.3%), nausea and vomiting (46.9%), diarrhea (37.5%), and dyspnea (37.5%). Laboratory findings revealed that the levels of C-reactive protein (75.0%), hemoglobin (51.6%), D-dimer (48.4%), lymphocytes (43.8%), LDH (45.3%), AST (42.2%), ALT (51.6%), and ferritin (48.4%) were above the reference values for a given age and gender. The clinical findings were similar to those observed in Kawasaki disease, although it represents a separate entity, emphasizing the need for proactive surveillance and early treatment.

O papel da atenção primária no combate ao Covid-19: impacto na saúde pública e perspectivas futuras / The role of primary care in the fight against the Covid-19: impact on public health and future perspectives / El papel de la atención primaria en la lucha contra el Covid-19: impacto en la salud pública y perspectivas futuras

A doença do novo Coronavírus (Covid-19) é causada pelo SARS-CoV-2 e representa o agente causador de uma doença potencialmente fatal que tem se revelado um problema de saúde pública global. A pandemia causada pelo Covid-19 tem causado prejuízos severos nos sistemas de saúde em diversos países. Diante do grande número de pessoas infectadas e da ausência de tratamento específico, várias nações têm enfrentado superlotação em seus hospitais. Com a confirmação de casos desta doença no Brasil, várias ações têm sido tomadas por gestores públicos e privados, tanto a nível hospitalar quanto em nível de atenção primária, a fim de minimizar os impactos para o Sistema Único de Saúde (SUS). O presente artigo apresenta uma breve análise do papel da atenção primária na luta contra o Covid-19 em âmbito nacional, além do impacto em saúde pública e das futuras perspectivas. Com base no grande número de pessoas infectadas no mundo e a experiência de diversos sistemas de saúde, torna-se imperativo a adaptação e adequação do SUS na condução de mecanismos de resposta para pandemia, sendo a atenção primária peça fundamental neste processo.

The new coronavirus (Covid-19) disease is caused by SARS-CoV-2 and represents the causative agent of a potentially fatal disease that has proved to be a global public health problem. The pandemic caused by Covid-19 has caused severe damage to health systems in several countries. In view of the large number of infected people and the lack of specific treatment, several nations have faced overcrowding in their hospitals. With the confirmation of cases of this disease in Brazil, several actions have been taken by managers, both at the hospital level and at the level of primary care, in order to minimize the damage in the Unified Health System (SUS). This article presents a brief analysis of the role of primary care in the fight against Covid-19 at the national level, in addition to the impact on public health and future perspectives. Based on the large number of infected people in the world and the experience of different health systems, it is imperative to adapt and adequation the SUS in conducting response mechanisms for the pandemic, with primary care being a fundamental part of this process.

La enfermedad del nuevo coronavirus (Covid-19) es causada por el SARS-CoV-2 y representa el agente causal de una enfermedad potencialmente mortal que ha demostrado ser un problema global de salud pública. La pandemia causada por Covid-19 ha causado graves daños a los sistemas de salud en varios países. En vista de la gran cantidad de personas infectadas y la falta de tratamiento específico, varias naciones han enfrentado hacinamiento en sus hospitales. Con la confirmación de los casos de esta enfermedad en Brasil, los gerentes han tomado varias medidas, tanto a nivel hospitalario como a nivel de atención primaria, para minimizar el daño en el Sistema Único de Salud (SUS). Este artículo presenta un breve análisis del papel de la atención primaria en la lucha contra Covid-19 en todo el país, además del impacto en la salud pública y las perspectivas futuras. Basado en la gran cantidad de personas infectadas en el mundo y la experiencia de diferentes sistemas de salud, es imperativo adaptar y adaptar el SUS en la conducción de mecanismos de respuesta a la pandemia, siendo la atención primaria una parte fundamental de este proceso.

Hand perforation caused by a Gafftopsail catfish (bagre marinus) in a fisherman from Northeastern Brazil / Perfuração da mão por bagre branco (bagre marinus) em pescador do nordeste do Brasil

A 39-year-old male fisherman from Ceará State in Northeastern Brazil presented to the emergency room complaining of intense pain, edema, and bleeding in his left hand (Figure 1A-1B), He had a recent history of traumatism with hand perforation caused by the stinger of a gafftopsail catfish (Bagre marinus) (Figure 2A-2C). The injury occurred 4 hours prior when pulling his fishnet in the ocean. Right after the injury, the patient presented local pain and classified as eight in a visual analogue scale of pain. He denied systemic symptoms such as fever. On physical examination, he presented with two perforations separated by about 2 cm with slight bleeding (Figure 1A), local edema, and pain in his left hand (Figure 1B). Local cleansing of the lesion was performed. He was advised to apply warm compresses and used analgesics/anti-inflammatory drugs with the improvement of the inflammation. Systemic antibiotics were not necessary.

Um pescador de 39 anos, natural do Ceará, na região Nordeste do Brasil, deu entrada na emergência com queixa de dor intensa, edema e sangramento no dorso da mão esquerda (figura 1A-1B). Ele apresentava história recente de trauma na mão por ferrão de bagre branco (bagre marinus). A lesão ocorreu durante o ato de puxar a rede do oceano, quatro horas antes do atendimento. Logo após a lesão, apresentou dor intensa, nota 8 na escala visual analógica de dor. Ele negou sintomas sistêmicos, como febre. No exame físico, apresentava duas perfurações separadas por cerca de 2 cm com leve sangramento (figura 1A), edema e dor na mão esquerda (figura 1B). Foi realizada limpeza da lesão. Alem disso, foi orientado a aplicar compressas mornas e fazer uso de analgésicos /anti-inflamatórios para a melhora da inflamação. Antibióticos sistêmicos não foram necessários.

Health system collapse 45 days after the detection of COVID-19 in Ceará, Northeast Brazil: a preliminary analysis

Abstract INTRODUCTION: COVID-19 emerged in late 2019 and quickly became a serious public health problem worldwide. This study aim to describe the epidemiological course of cases and deaths due to COVID-19 and their impact on hospital bed occupancy rates in the first 45 days of the epidemic in the state of Ceará, Northeastern Brazil. METHODS: The study used an ecological design with data gathered from multiple government and health care sources. Data were analyzed using Epi Info software. RESULTS: The first cases were confirmed on March 15, 2020. After 45 days, 37,268 cases reported in 85.9% of Ceará's municipalities, with 1,019 deaths. Laboratory test positivity reached 84.8% at the end of April, a period in which more than 700 daily tests were processed. The average age of cases was 67 (<1 - 101) years, most occurred in a hospital environment (91.9%), and 58% required hospitalization in an ICU bed. The average time between the onset of symptoms and death was 18 (1 - 56) days. Patients who died in the hospital had spent an average of six (0 - 40) days hospitalized. Across Ceará, the bed occupancy rate reached 71.3% in the wards and 80.5% in the ICU. CONCLUSIONS: The first 45 days of the COVID-19 epidemic in Ceará revealed a large number of cases and deaths, spreading initially among the population with a high socioeconomic status. Despite the efforts by the health services and social isolation measures the health system still collapsed.

Vesiculobullous exanthema in a 3-month-old child with probable acute chikungunya infection / Exantema vesiculobolhoso em criança de 3 meses com provável infecção aguda por chikungunya

Objective: to report a rare case of a 3-month-old child with acute chikungunya infection presenting as vesiculobullous rash. Case description: herein we report a case of a 3-month-old infant which developed a diffuse erythematous rash involving the trunk and limbs within two days after sudden acute fever, and also presented striking irritability with inconsolable crying, hyporexia, cough, and coryza. Hematological and biochemical investigations were undertaken and were found to be normal. Serum samples were tested for Chikungunya revealing positive IgM. He was treated with supportive therapy, mainly with antipyretics, venous hydration and rest evolving with entirely resolution of the symptoms after four days. Comments: Chikungunya fever is a disease caused by the Chikungunya virus which can be found in endemic areas such as Brazil. Atypical manifestations can affect various systems including the skin and may be more frequent in children. The role of dermatological manifestations related to Chikungunya infection is not completely understood. The reported case is an unusual case of Chikungunya infection which highlights the importance of to know and to be aware of this manifestation in children mainly in new endemic areas such as Brazil.

Objetivo: relatar o caso raro de uma criança de 3 meses de idade com infecção aguda por chikungunya apresentando-se como erupção vesiculobolhosa. Descrição do caso: aqui relatamos o caso de uma criança de 3 meses que evoluiu com erupção eritematosa difusa envolvendo tronco e membros dois dias após febre aguda repentina, além de apresentar irritabilidade marcante com choro inconsolável, hiporexia, tosse e coriza. Investigações hematológicas e bioquímicas foram realizadas e foram normais. Amostras de soro foram testadas para Chikungunya revelando IgM positiva. Ele foi tratado com terapia de suporte, principalmente com antipiréticos, hidratação venosa e descanso evoluindo com resolução completa dos sintomas após quatro dias. Comentários: a febre Chikungunya é uma doença causada pelo vírus Chikungunya, que pode ser encontrada em áreas endêmicas como o Brasil. Manifestações atípicas podem afetar vários sistemas, incluindo a pele, e podem ser mais frequentes em crianças. O papel das manifestações dermatológicas relacionadas à infecção por Chikungunya não é completamente compreendido. O caso relatado é um caso incomum de infecção por Chikungunya, que destaca a importância de conhecer e ter consciência dessa manifestação em crianças, principalmente em novas áreas endêmicas como o Brasil.