Hantavirus pulmonary syndrome in Brazil: clinical aspects of three new cases

Hantavirus pulmonary syndrome (HPS) has been recognized recently in Brazil, where 28 cases have been reported as of September 1999. We report here the clinical and laboratory findings of three cases whose diagnoses were confirmed serologically. All the patients were adults who presented a febrile illness with respiratory symptoms that progressed to respiratory failure that required artificial ventilation in two of them. Laboratory findings were most of the time consistent with those reported in the United States in patients infected with the Sin Nombre virus, and included elevated hematocrit and thrombocytopenia; presence of atypical lymphocytes was observed in one patient. The chest radiological findings observed in all the patients were bilateral, diffuse, reticulonodular infiltrates. Two patients died. Histopathological examination of the lungs of these patients revealed interstitial and alveolar edema, alveolar hemorrhage, and mild interstitial pneumonia characterized by infiltrate of immunoblasts and mononuclear cells. In the epidemiologic investigation of one of the cases, serologic (ELISA) tests were positive in 3 (25 percent) out of 12 individuals who shared the same environmental exposure. HPS should be included in the differential diagnosis of interstitial pneumonia progressing to acute respiratory failure

Chagas'disease and HIV co-infection: genotypic characterization of the Trypanosoma cruzi strain

In the past few years, new aspects of the immunopathology of Chagas' disease have been described in immunosuppressed patients, such as fatal central system lesions related to the reactivation of the parasite. This article is the first description of the genotypic characterization, at the strain level, of Trypanosoma cruzi isolated from a patient with Chagas' disease/AIDS co-infection. The presence of four hypodense lesions was observed in the cranial compute tomographic scan. The diagnosis of AIDS was assessed by the detection of anti-HIV antibodies using enzyme-linked immunosorbent assay (ELISA) and Western blot techniques. The CD4+ lymphocyte counts were maintained under 200 cells/mm cube number during one year demonstrating the severity of the state of immunosuppression. Chagas' disease was confirmed by serological and parasitological methods. Trypomastigote forms were visualized in a thick blood smear. The parasite isolated is genotypically similar to the CL strain. The paper reinforces that cerebral Chagas' disease can be considered as another potencial opportunistic infection in AIDS resulting from the reactivation of a dormant T. cruzi infection acquired years earlier.

Mielite transversa como manifestaçäo clínica inicial de linfoma näo Hodgkin disseminado e mielopatia vacuolar associada ao HIV: relato de caso / Transverse myelitis as initial symptom of disseminated non-Hodgkin lymphoma and HIV-associated vacuolar myelopathy: case report

Linfomas näo Hodgkin de alto grau sao comumente relatados em pacientes com a síndrome da imunodeficiência adquirida (AIDS). Comprometendo com grande frequência o sistema nervoso central, particularmente as leptomeninges e os hemisférios cerebrais. O acometimento epidural é pouco frequente, variando de 3,5 por cento a 8,3 por cento de acordo com os registros da literatura. Os autores relatam o caso de um paciente de 27 anos de idade com AIDS, cuja manifestaçao clínica inicial da doença linfomatosa disseminada foi a mielite transversa associada à mielopatia vacuolar. Destaca-se a importância do diagnóstico diferencial precoce das mielopatias na AIDS, em virtude da alta malignidade da neoplasia e da evoluçao extremamente rápida nesses pacientes.

Trypanosoma cruzi meningoencephalitis and myocarditis in a patient with acquired immunodeficiency syndrome

We report the case of a 52-year-old male heterosexual patient with acquired immunodeficiency syndrome (AIDS) and reactivation of Chagas' disease manifested by meningoencephalitis and myocarditis, diagnosed post-mortem. Unexplained reactivation of Chagas' disease should be included among the diagnostic criteria of AIDS in human immunodeficiency virus positive patients. On the other hand, AIDS should be considered in the differential diagnosis of patients with unexplained reactivation of Chagas' disease.

Esquistossomose do sistema nervoso central: relato de um caso / Schistosomiasis of the central nervous system: report of a case

O comprometimento do sistema nervoso na esquistossomose mansônica é evento raramente diagnosticado na evoluçäo desta parasitose. Os autores descrevem o caso de uma paciente de 23 anos, natural de Säo Francisco-MG, que apresentava há duas semanas quadro de cefaléia, vômitos em jato, febre e sonolência: o exame neurológico mostrava rigidez de nuca, paresta com hipertonia muscular bilateral em membros superiores, perda de motricidade e sensibilidade em membros inferiores. Näo se palpava hepato-esplenomegalia. O exame do líquido cefalorraquidiano (LCR) mostrou hipoglicorraqui (28 mg%), hiperproteinorraquia (113 mg%) e pleocitose acentuada (949 células/mm**3), com predomínio de neutrófilos (70%), além de eosinofilorraquia (9%). A reaçäo de imunofluorescência indireta para esquistossomose, no LCR, realizada em cortes de fígado com granuloma peri-ovular foi reagente (IgG: 1/16; IgM: 1/4). As pesquisas de fungos e b.a.a.r. no LCR, assim como a cultura para b.a.a.r. (apóos 60 dias) e as reaçöes imunológicas para neurocisticercose foram negativas. Uma tomografia computadorizada do cérebro e medula espinhal näo evidenciou anormalidades. No exame parasitológico das fezes foi identificada a presença de ovos viáveis de S. mansoni. Instituiu-se tratamento com corticóides e praziquantel (60 mg/kg/dia; 7 dias) tendo havido regressäo das alteraçöes do LCR, permanecendo entretanto seqüelas neurológicas graves (paraplegia e bexiga neurogênica)