ABSTRACT
Introduction The distribution of infection by Histoplasma capsulatum in Brazil is heterogeneous, and the number of cases affecting immunocompetent individuals is relatively small. This study reports the epidemiological and clinical data regarding histoplasmosis in non-immunosuppressed individuals. Methods The study included only the immunocompetent patients with histoplasmosis who were diagnosed between 1970 and 2012 at a university hospital located in Ribeirão Preto, State of São Paulo, Brazil. Clinical and epidemiological data were collected retrospectively from the patient records. Results Of the 123 patients analyzed, 95 had an active disease that manifested in the different clinical forms of histoplasmosis. Men were the predominant gender, and most patients resided in the Northeast of the State of São Paulo and in the nearby municipalities of the State of Minas Gerais. The risk factors for acquiring histoplasmosis and prolonged contact in a rural environment were recorded in 43.9% and 82.9% of cases, respectively. Smoking, alcoholism, and comorbidity rates were high among the patients with the chronic pulmonary and subacute/chronic disseminated forms of histoplasmosis. Many patients achieved clinical cure spontaneously, but 58.9% required antifungals; the disease lethality rate was 5.3%. Conclusions Immunocompetent individuals manifested the diverse clinical forms of histoplasmosis over a period of 4 decades, revealing an additional endemic area of this fungal disease in the Brazilian Southeast. .
Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Endemic Diseases , Histoplasmosis/epidemiology , Immunocompetence , Brazil/epidemiology , Histoplasmosis/immunology , Immunocompetence/immunology , Retrospective StudiesABSTRACT
INTRODUÇÃO: O tétano continua sendo um grave problema de saúde pública nos países em desenvolvimento. No Brasil, apesar dos avanços tecnológicos, não houve um decréscimo significativo da taxa de letalidade nos últimos anos. Nesta casuística, foram analisados dados clínicos e epidemiológicos dos pacientes diagnosticados em Ribeirão Preto, nas últimas duas décadas. MÉTODOS: Este é um estudo retrospectivo que analisou dados dos pacientes internados por tétano acidental no Hospital das Clínicas de Ribeirão Preto, entre 1990 e 2009. O diagnóstico do tétano foi realizado segundo critérios do Ministério da Saúde do Brasil. RESULTADOS: Onze (47,8%), casos positivos, dos 23 suspeitos de tétano, foram incluídos neste estudo. Não houve mortes, mas dois (18,2%) pacientes apresentaram déficit neurológico permanente. O indicador prognóstico Tetanus Severity Score variou entre 0 a 8 pontos. A mediana da permanência hospitalar foi de 17 dias, variando de 6 a 98 dias. A ausência de óbitos pode ser explicada pelo diagnóstico clinico precoce da doença com instituição imediata de terapia. CONCLUSÕES: Ribeirão Preto é uma área onde o tétano não é um relevante problema de saúde pública.
INTRODUCTION: Tetanus remains a major health problem in developing countries. In Brazil, despite technological advances, no significant decrease in the lethality rate of tetanus have been documented in recent years. Clinical and epidemiological data from patients who were treated in Ribeirão Preto in the state of São Paulo, Brazil in the last two decades were analyzed in this case series. METHODS: Retrospective data regarding the demographics, clinical presentations and prognoses of patients admitted with clinical suspicion of tetanus to a tertiary referral university hospital from 1990 to 2009 were identified. The tetanus diagnosis was defined according to the Brazilian Ministry of Health criteria. RESULTS: Eleven cases out of 23 patients with suspected tetanus were included in this study (47.8% of positive cases). The Tetanus Severity Score ranged from 0 to 8 points. There were no deaths, but two (18.2%) patients had permanent neurological deficits. The median length of hospital stay was 17 days (6-98 days). The absence of deaths can be explained by early clinical diagnosis and prompt treatment. CONCLUSIONS: Ribeirão Preto is an area in which tetanus is not a severe public health problem.