Acute respiratory distress syndrome due to vivax malaria: case report and literature review

Severe pulmonary involvement in malaria has been frequently reported in cases of Plasmodium falciparum infection, but rarely in vivax malaria. Among the 11 previous cases of vivax-related severe respiratory involvement described in the literature, all except one developed it after the beginning of anti-malarial treatment; these appear to correspond to an exacerbation of the inflammatory response. We report the case of a 43-year-old Brazilian woman living in a malaria-endemic area, who presented acute respiratory distress syndrome (ARDS) caused by P. vivax before starting anti-malarial treatment. The diagnosis was made based on microscopic methods. A negative rapid immunochromatographic assay, based on the detection of Histidine Rich Protein-2 (HRP-2) of P. falciparum, indicated that falciparum malaria was unlikely. After specific anti-plasmodial therapy and intensive supportive care, the patient was discharged from the hospital. We conclude that vivax malaria-associated ARDS can develop before anti-malarial therapy.

Estimated prevalence of viral hepatitis in the general population of the municipality of Säo Paulo, measures by a serologic survey of a stratified, randomized and residence-based population

The present study was done to estimate the prevalence of Hepatitis A (HAV), B (HBV), C (HCV), and E (HEV) infection in the general population residing in the municipality of Säo Paulo, and to evaluate the level of knowledge related to the various modes of infection transmission by and protection against the different viruses. Blood samples and health questionnaires were collected from 1,059 individuals. The study design used an inductive metod of predictive statistical inferences through randomized sampling stratifield by sex, age and residence region. The estimated prevalence rated found were: Hepatitis A = 66.59 percent (63.75 percent - 69.44 per cent CI); Hepatitis B = 5.94 percent (4.50 percent-7.35 percent); Hepatitis C =1.42 percent (0,70 percent - 2.12 percent); Hepatitis E = 1.68 percent (0.91 percent - 2.46 percent). The frequency of hepatitis was similar in males and females. HAV showed an estimated prevalence of 56.16 percent in the population up to 17 years old, increasing to 65.30 percent in individuals between 18 and 29 years. The infection reached its peak of 90 percent in individuals 40 years of age or older. The study showed a greater tendency of dissemination of HBV among the population between 15 and 17 years. This specific age group showed an estimated prevalence of active infection of 1.04 percent (0.43 percent - 1.65 percent CI), and also demonstrated an ascending level of acquired immunity with an estimated prevalence of 4.90 percent (3.60 percent - 6.20 percent CI). HCV demonstrated an estimated prevalence of 1.42 percent (0.70 percent - 2.12 percent CI). This specific infection occurred more frequently among adults 30 years of age or older, with the prevalence reaching a peak of 3.80 percent among the group aged 50 to 59 years. HEV showed zero prevalence among the age group between 2 and 9 years. This was followed by a slighty ascending rate starting from age 10, with an estimated prevalence of 1.05 percent (0.94 percent - 3.04 percent CI) among those 10 to 14 years of age....

Alteraçöes cardíacas na síndrome de imunodeficiência adquirida: relato de dois casos / Cardiac involvement in acquired immunodefficiency syndrome: report of 2 cases

Säo apresentados dois casos de pacientes com acometimento cardíaco na síndrome de imunodeficiência adquirida: o primeiro, menino de 14 anos, hemofílico, que desenvolveu insuficiência cardíaca congestiva com piora da funçäo miocárdica e septicemia por histoplasma capsulatum evoluindo a óbito. O segundo caso, um homem de 36 anos, homossexual, que, após quadro de pancreatite aguda, desenvolvou edema agudo pulmonar com falência ventricular esquerda e sorologia positiva para virus Coxsackie B3. Neste caso houve boa evoluçäo e normalizaçäo da funçäo miocárdica. Os autores ressaltam a possibilidade do acometimento cardíaco na síndrome de imunodeficiência adquirida