HCV Infection in Northeastern Brazil: unexpected high prevalence of genotype 3a and absence of African genotypes

The genomic diversity of HCV embraces 6 genoptypes and at least 52 subtypes with clinical and epidemiological correlations. There is a paucity of studiens assessing HCV genotypes and biomolecular epidemiology in Brazil. We studied genotypes distribution and epidemiological aspects in 232 HCV carriers, 133 ( 57,9 per cent) males and 99 (42,1 per cent) females, followed in the liver disease referral unit in Salvador, BA, northeastern Brazil. All of them were anti-HCV positive by 3rd generation ELISA assay, and HCV infection showed that 93 (40 per cent) had past blood transfusion, 14 (6 per cent) intravenous drug use, 19 (8 per cent) inhalation of cocaine, 28 (12 per cent) tattooing, 15 (7 per cent) were health care workers, 5 (2 per cent) had reused disposable syringes, 5 (2 per cent) had multiple risk factors and in 53 (23 per cent) no risk factor was determined.Genotypes 1a was observed in 75 (32 per cent), 1b in 72 (31 per cent), 3a in 61 (26 per cent), 2b in 14 (6 per cent): 5 (2.5 per cent) had mixed genotypes and 5 (2.5 per cent) were undetermined. Patients with genotype 1 had a higher mean age (P<0.05) and no particular risk factors were associated with a specific genotype. Genotype 1 largely predominates in northeast Brazil followed by genotype 3 which, in this population, does not seem to be related to intravenous drug abuse, in contrast to some European studies. Although 80 porcentage of the Salvador population comprise African-Brazilians, no Africa genotype was identified, which way mean that HCV was introduced into this region via European immigration. This study demonstrated some peculiarities of HCV epidemiology in Brazil and strongly suggests that HCV introduction to this region was probably related to European immigration.

Fasciite necrosante / Necrozing fasciitis

A fasciite necrosante deve-se a uma infecçäo polibacteriana incomum e é de prognóstico reservado. Neste trabalho, os autores apresentam dois casos ocorridos no Hospital Universitário de Santa Maria - Santa Maria - RS, no ano de 1988. Discutem a fisiopatologia e o tratamento mais adequado para a patologia. Ambas as infecçöes foram polimicrobianas. O tratamento insituído foi: medidas gerais para o choque séptico, antibioticoterapia de amplo espectro e debridamento cirúrgico radical. Houve sucesso terapêutico em um dos casos, com cura da infecçäo e reconstituiçäo da área debridada com enxertos. A outra paciente foi ao óbito no sétimo dia pós-operatório