Management of post-transplant Epstein-Barr virus-related lymphoproliferative disease in solid organ and hematopoietic stem cell recipients

Epstein-Barr virus (EBV)-related post-transplant lymphoproliferative disease (PTLD) is one of the most serious complications associated with solid organ and hematopoietic stem cell transplantation. PTLD is most frequently seen with primary EBV infection post-transplant, a common scenario for pediatric solid organ recipients. Risk factors for infection or reactivation of EBV following solid organ transplant are stronger immunosuppressive therapy regimens, and being seronegative for receptor. For hematopoietic stem cell transplantation, the risk factors relate to the type of transplant, human leukocyte antigen disparity, the use of stronger immunosuppressants, T-cell depletion, and severe graft-versus-host disease. Mortality is high, and most frequent in patients who develop PTLD in the first six months post-transplant. The primary goal of this article is to provide an overview of the clinical manifestations, diagnosis, accepted therapies, and management of EBV infection in transplant recipients, and to suggest that the adoption of monitoring protocols could contribute to a reduction in related complications.

Costs of care provided in a university hospital for children exposed to or infected with the HIV/AIDS

The objective of this study was to estimate and analyze the costs of treating children with HIV/AIDS at a university hospital in São Paulo, Brazil. The study collected and analyzed data from 291 medical records of children treated at the hospital as of March 2002. The costs of treatment were estimated for each category of patient (exposed and infected) and severity, based on the quantity of inputs and procedures used in treating each child, based on the cost accounting system used at the hospital. The total cost of treatment for children exposed to the HIV was R$ 956.41 and for those infected with HIV R$ 8,092.71 per year. The mean cost of ambulatory care was R$ 6,047.28 for children with severe conditions, R$ 3,714.45 for those with light/moderate conditions, and R$ 948.63 for the exposed. Hospitalized children had annual costs of R$ 19,353.34, R$ 18,823.16, and R$ 871.03, respectively. The medication was a major factor in the cost of treatment. Our estimates are comparable to the findings from other studies, but lower than corresponding findings from the international literature.

O objetivo deste estudo foi estimar e analisar os custos de tratamento da criança com HIV/AIDS em um hospital universitário de São Paulo, Brasil. Foram analisados 291 prontuários de crianças expostas ou infectadas acompanhadas no Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, em março de 2002. O custo foi estimado por categoria de paciente (exposta e infectada) e nível de gravidade (graves e leves/moderados), com base na quantidade de procedimentos e insumos utilizados no tratamento, e valorizado monetariamente por meio do sistema de apuração de custos existente no Instituto da Criança. O custo total estimado de tratamento da criança exposta ao HIV foi de R$ 956,41 e da criança infectada de R$ 8.092,71 por ano. O custo do tratamento ambulatorial foi de R$ 6.047,28, R$ 3.714,45 e R$ 948,63, respectivamente para os pacientes infectados graves, leves/moderados e para as crianças expostas, e o custo médio de internação foi de R$ 19.353,34, R$ 18.823,16 e R$ 871,03, respectivamente. O custo foi fortemente influenciado pelo consumo de medicamentos e comparável aos obtidos pelos demais estudos publicados, embora inferior ao estimado em estudos internacionais.

Hyperlipidaemia a risk factor for femoral head osteonecrosis (Legg-Calv -Perthes-like disease) in children with AIDS: case report

Although treatment of children infected with HIV with protease inhibitors has improved the survival of these patients, various adverse side effects have been reported, including metabolic abnormalities, such as hyperlipidaemia. We describe a case of hip osteonecrosis in an adolescent with AIDS who was being treated with protease inhibitors. There is a possible relation with hyperlipidemia. F.M.G., white, 11 years old, AIDS A2, started to receive AZT and DDI when he was 7 years old. In April 1999, the patient had a significant increase in viral load and so the antiretroviral therapy was switched to d4T, 3TC and Ritonavir. Triglyceride plasma levels reached 460mg/dl after this switch and were always above the reference value. In December 1999, the patient complained of pain in the right hip. On physical examination, he had limited movement of this joint. Magnetic resonance imaging of the right hip showed flattening, deformity and fragmentation of the femoral head, compatible with osteonecrosis. Few cases of femoral head osteonecrosis have been associated with HIV infection, in the absence of the classic risk factors for osteonecrosis. Metabolic risk factors include hypertriglyceridaemia. The immunological disorders that occur in the HIV infection may predispose the patient to avascular osteonecrosis and metabolic disorders, particularly hypertriglyceridemia, while the use of protease inhibitors, may be considered an additional risk factor for osteonecrosis. Given the importance of premature diagnosis and to avoid complications of osteonecrosis, we recommend evaluation of musculoskeletal symptoms in children receiving protease inhibitors.

Aspergillosis in immunocompromised children with acute myeloid leukemia and bone marrow aplasia: report of two cases

No presente trabalho sao registrados dois casos de aspergilose em criancas imunocomprometidas. O estudo micologico completo identificou Aspergillus flavus como agente de dois processos. A presenca cada vez mais frequente da aspergilose invasiva deve-se ao numero crescente de pacientes imunocomprometidos, muitos com hemopatias graves submetidos a quimioterapia. O diagnostico precoce em um dos casos possibilitou remissao do processo. Tratava-se de paciente com leucemia mieloide aguda, tendo sido isolado o fungo do sangue circulante. O segundo caso evoluiu para obito, com infeccao fungica generalizada.

Paracoccidioidomicose na infância: diagnóstico por imagens; relato de um caso / Paracoccidioidomycosis in childhood

Os autores relatam o caso de uma criança do sexo feminino, de oito anos de idade, portadora de paracoccidioidomicose profunda, com febre intermitente, hepatomegalia, linfadenopatia abdominal, comprometimento do esqueleto com lesöes ósseas do tipo osteolítico, acompanhado de aumento das partes moles e cardiomegalia com derrame pericárdio, sem acometimento pulmonar

Sistemas de informaçäo em saúde: como usar fontes de dados para a geraçäo de indicadores epidemiológicos; oficina de trabalho / Health information systems: how to use data sources for generation of epidemiological indicators; workshop

Propöe concepçöes fundamentais para a elaboraçäo de uma nova política de informaçöes em saúde: elaborar a política através de consensos construídos a partir de experiências; definir claramente os papéis institucionais e técnicos a níveis locais, estaduais e federais; usar abordagens interdisciplinares e intersetoriais; enfatizar o nível local; transformar a busca da qualidade das informaçöes produzidas como um processo contínuo (AMSB)