ABSTRACT
Abstract From the discovery of the Zika virus (ZIKV) in 1947 in Uganda (Africa), until its arrival in South America, it was not known that it would affect human reproductive life so severely. Today, damagetothe central nervous system is known to be multiple, and microcephaly is considered the tip of the iceberg. Microcephaly actually represents the epilogue of this infection's devastating process on the central nervous system of embryos and fetuses. As a result of central nervous system aggression by the ZIKV, this infection brings the possibility of arthrogryposis, dysphagia, deafness and visual impairment. All of these changes of varying severity directly or indirectly compromise the future life of these children, and are already considered a congenital syndrome linked to the ZIKV. Diagnosis is one of the main difficulties in the approach of this infection. Considering the clinical part, it has manifestations common to infections by the dengue virus and the chikungunya fever, varying only in subjective intensities. The most frequent clinical variables are rash, febrile state, non-purulent conjunctivitis and arthralgia, among others. In terms of laboratory resources, there are also limitations to the subsidiary diagnosis. Molecular biology tests are based on polymerase chain reaction (PCR)with reverse transcriptase (RT) action, since the ZIKV is a ribonucleic acid (RNA) virus. The RT-PCR shows serum or plasma positivity for a short period of time, no more than five days after the onset of the signs and symptoms. The ZIKVurine test is positive for a longer period, up to 14 days. There are still no reliable techniques for the serological diagnosis of this infection. If there are no complications (meningoencephalitis or Guillain-Barré syndrome), further examination is unnecessary to assess systemic impairment. However, evidence is needed to rule out other infections that also cause rashes, such as dengue, chikungunya, syphilis, toxoplasmosis, cytomegalovirus, rubella, and herpes. There is no specific antiviral therapy against ZIKV, and the therapeutic approach to infected pregnant women is limited to the use of antipyretics and analgesics. Anti-inflammatory drugs should be avoided until the diagnosis of dengue is discarded. There is no need to modify the schedule of prenatal visits for pregnant women infected by ZIKV, but it is necessary to guarantee three ultrasound examinations during pregnancy for low-risk pregnancies, and monthly for pregnant women with confirmed ZIKV infection. Vaginal delivery and natural breastfeeding are advised.
Resumo Desde a descoberta do vírus Zika (VZIK) em 1947 em Uganda, na África, até sua chegada na América do Sul, não se tinha notícia de que ele seria capaz de comprometer a vida reprodutiva emhumanos de forma tão severa.Hoje, sabe-se que os danos sobre o sistema nervoso central são múltiplos, e a microcefalia é considerada a ponta do iceberg, visto que na realidade ela representa o epílogo de um processo devastador desta infecção sobre o sistema nervoso central do embrião e do feto. Em decorrência da agressão do sistema nervoso central pelo VZIK, esta infecção pode provocar artrogripose, disfagia, surdez e comprometimento visual. Todas estas alterações, de gravidade variável, direta ou indiretamente comprometem a vida futura dessas crianças, já sendo considerada uma síndrome congênita ligada aoVZIK. Uma das principais dificuldades na abordagemdessa infecção é relativa ao diagnóstico. Considerando a parte clínica, observa-se que ela apresenta manifestações comuns às infecções pelos vírus da dengue e da febre chikungunya, variando apenasemsuas intensidades subjetivas. As variáveis clínicas mais frequentes são o exantema, febrícula, conjuntivite não purulenta e artralgia. No tocante aos recursos laboratoriais, também existem limitações ao diagnóstico subsidiário. As provas de biologia molecular se fundamentam na reação em cadeia da polimerase (RCP) com ação da transcriptase reversa (TT), visto que o VZIK é umvírus ácido ribonucleico (ARN). ATRRCP apresenta positividade sérica ou plasmática por um período curto de tempo, não ultrapassando cinco dias após início dos sinais e sintomas. Esta pesquisa do VZIK na urina fica positiva por período mais prolongado, chegando a 14 dias. Ainda não existem técnicas seguras para diagnóstico sorológico dessa infecção. Não havendo complicações (meningoencefalite ou síndrome de Guillain-Barré), dificilmente são necessários mais exames complementares para avaliar o comprometimento sistêmico.No entanto, são necessáriasprovaspara descartar as outras infecções que causam exantema, como dengue, chikungunya, sífilis, toxoplasmose, citomegalovírus, rubéola e herpes. Sabe-se que não existe terapia antiviral específica contra o VZIK, e a abordagem terapêutica de gestantes portadoras da infecção limita-se ao uso de antitérmicos e analgésicos. Orienta-se evitar anti-inflamatórios até que o diagnóstico de dengue seja descartado. Sobre a condução do pré-natal, não há necessidade de modificar o cronograma de consultas pré-natais para gestantes que foram infectadas pelo VZIK, mas é necessária a garantia de três exames ecográficos durante a gravidez para gestantes de baixo risco, emensais para a gestante cominfecção confirmada pelo VZIK. Avia de parto é vaginal, e está liberado o aleitamento natural.
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/therapy , Zika Virus Infection/diagnosis , Zika Virus Infection/therapy , Zika Virus Infection/transmission , Microcephaly/virology , Prenatal Care , Microcephaly/diagnosis , Microcephaly/embryology , Microcephaly/therapyABSTRACT
Paracoccidioidomycosis and histoplasmosis are systemic fungal infections endemic in Brazil. Disseminated clinical forms are uncommon in immunocompetent individuals. We describe two HIV-negative patients with disseminated fungal infections, paracoccidioidomycosis and histoplasmosis, who were diagnosed by biopsies of suprarenal lesions. Both were treated for a prolonged period with oral antifungal agents, and both showed favorable outcomes.
A paracoccidioidomicose e a histoplasmose são infecções fúngicas sistêmicas endêmicas no Brasil. As formas clínicas disseminadas são incomuns em pacientes imunocompetentes. Nós descrevemos dois pacientes HIV-negativos com infecções fúngicas disseminadas, paracoccidioidomicose e histoplasmose, que foram diagnosticadas por biópsias de lesões de supra-renal. Ambos foram tratados por períodos prolongados com antifúngicos orais, evoluindo com boa resposta terapêutica.
Subject(s)
Humans , Male , Middle Aged , Adrenal Gland Diseases/diagnosis , Central Nervous System Fungal Infections/diagnosis , Facial Dermatoses/diagnosis , Histoplasmosis/diagnosis , Paracoccidioidomycosis/diagnosis , Adrenal Gland Diseases/microbiology , Biopsy , Brazil , Central Nervous System Fungal Infections/microbiology , Facial Dermatoses/microbiology , Immunocompetence/physiologyABSTRACT
OBJECTIVES: To collect data about non-controlled prescribing use of daptomycin and its impact among Brazilian patients with serious Gram positive bacterial infection, as well as the efficacy and safety outcomes. MATERIALS AND METHODS: This is a multi-center, retrospective, non-interventional registry (August 01, 2009 to June 30, 2011) to collect data on 120 patients (44 patients in the first year and 76 patients in the second year) who had received at least one dose of commercial daptomycin in Brazil for the treatment of serious Gram-positive bacterial infection. RESULTS: Right-sided endocarditis (15.8%), complicated skin and soft tissue infections (cSSTI)wound (15.0%) and bacteremia-catheter-related (14.2%) were the most frequent primary infections; lung (21.7%) was the most common site for infection. Daptomycin was used empirically in 76 (63.3%) patients, and methicillin-resistant Staphylococcus aureus (MRSA) was the most common suspected pathogen (86.1%). 82.5% of the cultures were obtained prior to or shortly after initiation of daptomycin therapy. Staphylococcus spp. - coagulase negative, MRSA, and methicillin-susceptible S. aureus were the most frequently identified pathogens (23.8%, 23.8% and 12.5%, respectively). The most common daptomycin dose administered for bacteremia and cSSTI was 6 mg/kg (30.6%) and 4 mg/kg (51.7%), respectively. The median duration of inpatient daptomycin therapy was 14 days. Most patients (57.1%) did not receive daptomycin while in intensive care unit. Carbapenem (22.5%) was the most commonly used antibiotic concomitantly. The patients showed clinical improvement after two days (median) following the start of daptomycin therapy. The clinical success rate was 80.8% and the overall rate of treatment failure was 10.8%. The main reasons for daptomycin discontinuation were successful end of therapy (75.8%), switched therapy (11.7%), and treatment failure (4.2%). Daptomycin demonstrated a favorable safety and tolerability profile regardless of treatment duration. CONCLUSIONS: Daptomycin had a relevant role in the treatment of Gram-positive infections in the clinical practice setting in Brazil.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Anti-Bacterial Agents/therapeutic use , Daptomycin/therapeutic use , Gram-Positive Bacterial Infections/drug therapy , Anti-Bacterial Agents/adverse effects , Brazil , Daptomycin/adverse effects , Registries , Retrospective Studies , Treatment OutcomeSubject(s)
HIV Infections/pathology , Occupational Dentistry , Occupational Dentistry/education , Acquired Immunodeficiency Syndrome/pathology , Communicable Diseases/epidemiology , Communicable Diseases/pathology , Communicable Diseases/transmission , HIV Infections/prevention & control , HIV Infections/therapy , HIV Infections/transmission , Acquired Immunodeficiency Syndrome/prevention & control , Acquired Immunodeficiency Syndrome/therapy , Infectious Disease Transmission, Patient-to-Professional , Infectious Disease Transmission, Professional-to-PatientABSTRACT
Mulher de 17 anos com prolapso de valvas mitral e tricúspide com sinais de degeneraçäo mixomatosa apresentou infecçäo puerperal por Staphylococcus aureus, com sepse e múltiplas embolias sépticas (órbita e globo ocular direitos, polegar esquerdo, baço, flegmäo em gastrocnêmio esquerdo), resultando histerectomia total dno 10§ dia pós-parto e enucleaçäo do globo ocular direito no 16§. Foram diagnosticadas endocardite infecciosa e insuficiência mitral aguda e realizada substituiçäo mitral no 13§ dia pós-parto, ocorrendo bloqueio átrio-ventricular total (BAVT) - necessitando de utilizaçäo de estimulaçäo artificial temporária - no 14§ dia pós-parto, bem como endocardite e insuficiência na tricúspide no 46§ dia pós-parto. A paciente recebeu alta no 62§ dia pós-parto em boas condiçöes clínicas, após término da antibioticoterapia
A 17-year-old woman with mitral and tricuspid valve prolapse and mizomatous degeneration presented puerperal infection by Staphylococcus aureus with clinical picture of sepsis and multiple septic embolism (right eye, left thumb, spleen, and left calf). She underwent total hysterectomy on the 10th day postdelivery and right eye enucleation on the 16th. Temporary total AV block occurred on the 14th day with temporary external pacing during the next couple of days. Acute endocarditis with acute mitral regurgitation was diagnosed on the 13th day, demanding immediate valve replacement. On the 46th day she developed moderate tricuspid valve regurgitation due to another episode of endocarditis. Final clinical discharge took place on the 62nd day after antibiotic therapy completion.
Subject(s)
Humans , Female , Adolescent , Endocarditis, Bacterial/etiology , Puerperal Infection/complications , Staphylococcus aureus/isolation & purification , Echocardiography, Doppler , Mitral Valve Prolapse/complications , Tricuspid Valve Prolapse/complicationsABSTRACT
Aborda-se as perspectivas futuras em relaçäo à AIDS, discutindo-se as com base na etiologia e patogenia da doença, em sua história natural e aspectos clínicos. A seguir, analisam-se as perspectivas terapêuticas, considerando as infecçöes oportunistas, o tratamento específico da infecçäo pelo HIV, assim como, a possível obtençäo de agente vacinal eficaz
Subject(s)
Humans , Acquired Immunodeficiency Syndrome , PrognosisABSTRACT
Säo descritos os achados clínico-laboratoriais de cinco doentes com leishmaniose visceral (Calazar), correlacionando-os com os aspectos morfológicos evidenciados à microscopia óptica e eletrônica em fragmentos de tecido hepático obtidos após o término da terapêutica com antimonial pentavalente. Em todos os casos pode-se verificar presença de proliferaçäo da trama reticulínica intra-sinusoidal concomitante à presença de fibrose intralobular que, muitas vezes, englobava grupos de hepatócitos. A microscopia eletrônica constatou-se preenchimento dos espaços sinusoidais pela emissäo de filopódios e pseudópodos a partir das células de Kuppfer, ao mesmo tempo em que se observava intensa atividade fibrilogênica. Os autores enfatizam a necessidade de estudos com maior tempo de acompanhamento, com o que será possível o estabelecimento da real magnitude do fato e suas conseqüências