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Article in English | LILACS-Express | LILACS | ID: biblio-1376307


ABSTRACT Capnocytophaga canimorsus is a gram-negative rod that is part of the commensal microbiota of dogs' and cats' mouths. In this case, we report an 85-year-old man with COVID-19 who had his right arm bitten by a dog. His symptoms were impaired consciousness, agitation and aggressive behavior. Physical examination revealed neck stiffness and Brudzinski's sign. The cerebrospinal fluid culture was compatible with Capnocytophaga canimorsus. He required intensive care and received a 14-day prescription of meropenem. After 40 days of hospitalization, the patient was fully recovered and was discharged. This case highlights the importance of physician and microbiologist be awareness of this disease, mainly in patients with neurological symptoms after a dog or cat bite.

Article in English | LILACS-Express | LILACS | ID: biblio-1360798


ABSTRACT The global pandemic of COVID-19 is caused by the novel coronavirus SARS-CoV-2, which often causes flu-like symptoms and can progress to severe respiratory illness. Thus, as the disease spreads, COVID-19 cases have multiplied across the world, and manifestations involving multiple systems have been described. We report a case of COVID-19-associated meningoencephalitis in a Brazilian male patient who presented with seizures and altered mental status. To the best of our knowledge, this is the first reported case of COVID-19-associated meningoencephalitis in Brazil. COVID-19-associated meningoencephalitis is a rare manifestation of this viral infection and clinicians should be aware of this possible complication.

J. Health Biol. Sci. (Online) ; 9(1): 1-4, 2021. ilus, tab
Article in English | LILACS | ID: biblio-1352545


Introduction: Mucormycosis is an infection caused by the ubiquitous saprophyte fungi with rapid and aggressive progression, especially in immunocompromised patients. Case report: A 57-year-old woman diagnosed with rhino-orbital mucormycosis presented with decreased renal function after treatment with amphotericin B deoxycholate which was discontinued. Renal function improved after amphotericin B lipid-complex, being also treated with itraconazole, and otorhinolaryngological surgery. Conclusion: The use of Amphotericin B deoxycholate may result in adverse effects. In this situation, Amphotericin B lipid formulation is usually the drug of choice.

Introdução: A mucormicose é uma infecção causada por fungos saprófitos com progressão rápida e agressiva, principalmente em pacientes imunocomprometidos. Relato de caso: Uma paciente de 57 anos, do sexo feminine, com diagnóstico de mucormicose rinorbital apresentou diminuição da função renal após tratamento com anfotericina B desoxicolato que foi descontinuada. A função renal foi recuperada após troca da terapia por anfotericina B complexo lipídico, sendo tratada também com itraconazol e cirurgia otorrinolaringológica. Conclusão: O uso de anfotericina B desoxicolato pode resultar em efeitos adversos. Nestas situações a formulação lipídica da anfotericina B é geralmente a droga de escolha.

Amphotericin B , Mucormycosis , Therapeutics , Pharmaceutical Preparations , Chemistry, Pharmaceutical , Drug-Related Side Effects and Adverse Reactions , Renal Insufficiency , Infections , Lipids
Rev. Soc. Bras. Med. Trop ; 54: e03832021, 2021. tab, graf
Article in English | LILACS | ID: biblio-1347098


Abstract In this study, we report the occurrence of multisystemic inflammatory syndrome among 64 children (2 deaths) with recent severe acute respiratory syndrome-related coronavirus 2 (SARS-COV-2) infections in the northeast region of Brazil. The major clinical symptoms and signs reported were exanthema (60.9%), abdominal pain (56.3%), nausea and vomiting (46.9%), diarrhea (37.5%), and dyspnea (37.5%). Laboratory findings revealed that the levels of C-reactive protein (75.0%), hemoglobin (51.6%), D-dimer (48.4%), lymphocytes (43.8%), LDH (45.3%), AST (42.2%), ALT (51.6%), and ferritin (48.4%) were above the reference values for a given age and gender. The clinical findings were similar to those observed in Kawasaki disease, although it represents a separate entity, emphasizing the need for proactive surveillance and early treatment.

Humans , Child , COVID-19 , Mucocutaneous Lymph Node Syndrome/epidemiology , Brazil/epidemiology , Pandemics , SARS-CoV-2
Rev. bras. med. fam. comunidade ; 15(42): 2455-2455, 20200210. ilus
Article in Portuguese | LILACS, ColecionaSUS | ID: biblio-1097400


A doença do novo Coronavírus (Covid-19) é causada pelo SARS-CoV-2 e representa o agente causador de uma doença potencialmente fatal que tem se revelado um problema de saúde pública global. A pandemia causada pelo Covid-19 tem causado prejuízos severos nos sistemas de saúde em diversos países. Diante do grande número de pessoas infectadas e da ausência de tratamento específico, várias nações têm enfrentado superlotação em seus hospitais. Com a confirmação de casos desta doença no Brasil, várias ações têm sido tomadas por gestores públicos e privados, tanto a nível hospitalar quanto em nível de atenção primária, a fim de minimizar os impactos para o Sistema Único de Saúde (SUS). O presente artigo apresenta uma breve análise do papel da atenção primária na luta contra o Covid-19 em âmbito nacional, além do impacto em saúde pública e das futuras perspectivas. Com base no grande número de pessoas infectadas no mundo e a experiência de diversos sistemas de saúde, torna-se imperativo a adaptação e adequação do SUS na condução de mecanismos de resposta para pandemia, sendo a atenção primária peça fundamental neste processo.

The new coronavirus (Covid-19) disease is caused by SARS-CoV-2 and represents the causative agent of a potentially fatal disease that has proved to be a global public health problem. The pandemic caused by Covid-19 has caused severe damage to health systems in several countries. In view of the large number of infected people and the lack of specific treatment, several nations have faced overcrowding in their hospitals. With the confirmation of cases of this disease in Brazil, several actions have been taken by managers, both at the hospital level and at the level of primary care, in order to minimize the damage in the Unified Health System (SUS). This article presents a brief analysis of the role of primary care in the fight against Covid-19 at the national level, in addition to the impact on public health and future perspectives. Based on the large number of infected people in the world and the experience of different health systems, it is imperative to adapt and adequation the SUS in conducting response mechanisms for the pandemic, with primary care being a fundamental part of this process.

La enfermedad del nuevo coronavirus (Covid-19) es causada por el SARS-CoV-2 y representa el agente causal de una enfermedad potencialmente mortal que ha demostrado ser un problema global de salud pública. La pandemia causada por Covid-19 ha causado graves daños a los sistemas de salud en varios países. En vista de la gran cantidad de personas infectadas y la falta de tratamiento específico, varias naciones han enfrentado hacinamiento en sus hospitales. Con la confirmación de los casos de esta enfermedad en Brasil, los gerentes han tomado varias medidas, tanto a nivel hospitalario como a nivel de atención primaria, para minimizar el daño en el Sistema Único de Salud (SUS). Este artículo presenta un breve análisis del papel de la atención primaria en la lucha contra Covid-19 en todo el país, además del impacto en la salud pública y las perspectivas futuras. Basado en la gran cantidad de personas infectadas en el mundo y la experiencia de diferentes sistemas de salud, es imperativo adaptar y adaptar el SUS en la conducción de mecanismos de respuesta a la pandemia, siendo la atención primaria una parte fundamental de este proceso.

Humans , Male , Female , Primary Health Care , Public Health , Coronavirus Infections , National Health Strategies , Pandemics
J. Health Biol. Sci. (Online) ; 8(1): 1-2, 20200101. ilus
Article in English | LILACS | ID: biblio-1130008


A 39-year-old male fisherman from Ceará State in Northeastern Brazil presented to the emergency room complaining of intense pain, edema, and bleeding in his left hand (Figure 1A-1B), He had a recent history of traumatism with hand perforation caused by the stinger of a gafftopsail catfish (Bagre marinus) (Figure 2A-2C). The injury occurred 4 hours prior when pulling his fishnet in the ocean. Right after the injury, the patient presented local pain and classified as eight in a visual analogue scale of pain. He denied systemic symptoms such as fever. On physical examination, he presented with two perforations separated by about 2 cm with slight bleeding (Figure 1A), local edema, and pain in his left hand (Figure 1B). Local cleansing of the lesion was performed. He was advised to apply warm compresses and used analgesics/anti-inflammatory drugs with the improvement of the inflammation. Systemic antibiotics were not necessary.

Um pescador de 39 anos, natural do Ceará, na região Nordeste do Brasil, deu entrada na emergência com queixa de dor intensa, edema e sangramento no dorso da mão esquerda (figura 1A-1B). Ele apresentava história recente de trauma na mão por ferrão de bagre branco (bagre marinus). A lesão ocorreu durante o ato de puxar a rede do oceano, quatro horas antes do atendimento. Logo após a lesão, apresentou dor intensa, nota 8 na escala visual analógica de dor. Ele negou sintomas sistêmicos, como febre. No exame físico, apresentava duas perfurações separadas por cerca de 2 cm com leve sangramento (figura 1A), edema e dor na mão esquerda (figura 1B). Foi realizada limpeza da lesão. Alem disso, foi orientado a aplicar compressas mornas e fazer uso de analgésicos /anti-inflamatórios para a melhora da inflamação. Antibióticos sistêmicos não foram necessários.

Accidents, Occupational , Pain , Catfishes , Edema , Hand
Rev. Soc. Bras. Med. Trop ; 53: e20200354, 2020. tab, graf
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1136826


Abstract INTRODUCTION: COVID-19 emerged in late 2019 and quickly became a serious public health problem worldwide. This study aim to describe the epidemiological course of cases and deaths due to COVID-19 and their impact on hospital bed occupancy rates in the first 45 days of the epidemic in the state of Ceará, Northeastern Brazil. METHODS: The study used an ecological design with data gathered from multiple government and health care sources. Data were analyzed using Epi Info software. RESULTS: The first cases were confirmed on March 15, 2020. After 45 days, 37,268 cases reported in 85.9% of Ceará's municipalities, with 1,019 deaths. Laboratory test positivity reached 84.8% at the end of April, a period in which more than 700 daily tests were processed. The average age of cases was 67 (<1 - 101) years, most occurred in a hospital environment (91.9%), and 58% required hospitalization in an ICU bed. The average time between the onset of symptoms and death was 18 (1 - 56) days. Patients who died in the hospital had spent an average of six (0 - 40) days hospitalized. Across Ceará, the bed occupancy rate reached 71.3% in the wards and 80.5% in the ICU. CONCLUSIONS: The first 45 days of the COVID-19 epidemic in Ceará revealed a large number of cases and deaths, spreading initially among the population with a high socioeconomic status. Despite the efforts by the health services and social isolation measures the health system still collapsed.

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Pneumonia, Viral/epidemiology , Bed Occupancy/statistics & numerical data , Betacoronavirus , Health Services Needs and Demand/statistics & numerical data , Pneumonia, Viral/mortality , Time Factors , Brazil/epidemiology , Sex Distribution , Coronavirus Infections , Coronavirus Infections/mortality , Coronavirus Infections/epidemiology , Age Distribution , Health Care Surveys/statistics & numerical data , Pandemics , Data Analysis , Hospital Units/statistics & numerical data , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Middle Aged
J. Health Biol. Sci. (Online) ; 7(4): 429-431, 30/09/2019.
Article in Portuguese | LILACS | ID: biblio-1023317


Objective: to report a rare case of a 3-month-old child with acute chikungunya infection presenting as vesiculobullous rash. Case description: herein we report a case of a 3-month-old infant which developed a diffuse erythematous rash involving the trunk and limbs within two days after sudden acute fever, and also presented striking irritability with inconsolable crying, hyporexia, cough, and coryza. Hematological and biochemical investigations were undertaken and were found to be normal. Serum samples were tested for Chikungunya revealing positive IgM. He was treated with supportive therapy, mainly with antipyretics, venous hydration and rest evolving with entirely resolution of the symptoms after four days. Comments: Chikungunya fever is a disease caused by the Chikungunya virus which can be found in endemic areas such as Brazil. Atypical manifestations can affect various systems including the skin and may be more frequent in children. The role of dermatological manifestations related to Chikungunya infection is not completely understood. The reported case is an unusual case of Chikungunya infection which highlights the importance of to know and to be aware of this manifestation in children mainly in new endemic areas such as Brazil.

Objetivo: relatar o caso raro de uma criança de 3 meses de idade com infecção aguda por chikungunya apresentando-se como erupção vesiculobolhosa. Descrição do caso: aqui relatamos o caso de uma criança de 3 meses que evoluiu com erupção eritematosa difusa envolvendo tronco e membros dois dias após febre aguda repentina, além de apresentar irritabilidade marcante com choro inconsolável, hiporexia, tosse e coriza. Investigações hematológicas e bioquímicas foram realizadas e foram normais. Amostras de soro foram testadas para Chikungunya revelando IgM positiva. Ele foi tratado com terapia de suporte, principalmente com antipiréticos, hidratação venosa e descanso evoluindo com resolução completa dos sintomas após quatro dias. Comentários: a febre Chikungunya é uma doença causada pelo vírus Chikungunya, que pode ser encontrada em áreas endêmicas como o Brasil. Manifestações atípicas podem afetar vários sistemas, incluindo a pele, e podem ser mais frequentes em crianças. O papel das manifestações dermatológicas relacionadas à infecção por Chikungunya não é completamente compreendido. O caso relatado é um caso incomum de infecção por Chikungunya, que destaca a importância de conhecer e ter consciência dessa manifestação em crianças, principalmente em novas áreas endêmicas como o Brasil.

Chikungunya virus , Chikungunya Fever , Skin Diseases , Skin Diseases, Vesiculobullous , Exanthema
J. Health Biol. Sci. (Online) ; 7(1): 101-103, jan.-mar. 2019.
Article in English | LILACS | ID: biblio-1005507


Introduction: Cutaneous larva migrans is a cutaneous infestation caused by zoonotic nematode larvae commonly due to hookworms such as the Ancylostoma braziliense. Case report: Herein we report a case of a 7-year-old child to the Emergency Department complaining of erythematous papular itching lesions on his right elbow, wrist and knee. He had no previous history of contact with sand or animals. The lesions in his right elbow presented impetiginization. Ivermectin 200mcg/kg/day treatment was initiated and oxacillin associated. On the third day of treatment, the patient was discharged with complete resolution of the lesions. Coclusion: The reported case assumes importance because it is a common and benign disease, but due to an unusual presentation was not diagnosed early. The disseminated form commonly may require hospitalization and prolonged treatment as presented

Introdução: A larva migrans cutânea é uma infestação cutânea causada por larvas de nematoides zoonóticos comumente causadas por ancilostomídeos como o Ancylostoma braziliense. Relato de caso: Aqui, relatamos o caso de uma criança de 7 anos de idade levada ao Departamento de Emergência, queixando-se de lesões eritematosas de prurido no cotovelo, punho e joelho direitos. Negava história prévia de contato com areia ou animais. As lesões no cotovelo direito apresentavam impetiginização. Ivermectina 200mcg/kg/dia foi iniciada e oxacilina associada. No terceiro dia de tratamento, o paciente recebeu alta com resolução completa das lesões. Conclusão: O caso relatado assume importância por ser uma doença comum e benigna, mas devido a uma apresentação incomum não foi diagnosticada precocemente. A forma disseminada comumente pode requerer hospitalização e tratamento.

Larva Migrans , Pediatrics , Communicable Diseases , Dermatology , Ectoparasitic Infestations
Rev. Soc. Bras. Med. Trop ; 52: e20180232, 2019. tab, graf
Article in English | LILACS | ID: biblio-1041517


Abstract INTRODUCTION: Chikungunya infection presents with distinct clinical features depending on the patient age group. METHODS: Medical records of children with positive IgM for the chikungunya virus who were hospitalized in a pediatric ward in Fortaleza, Ceará, Brazil were analyzed. RESULTS: Fourteen children with a median age of 4 months (36 days to 15 years) were included. All patients presented with fever persisting for an average of 5 days. The joints were involved in 6 (42.8%) children, and 8 (57.1%) children presented with bullous rash. CONCLUSIONS: Systemic involvement and atypical clinical manifestations characterize severe forms of chikungunya infection in children.

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Chikungunya Fever/complications , Chikungunya Fever/diagnosis , Chikungunya Fever/blood , Severity of Illness Index , Hospitalization
Medicina (Ribeiräo Preto) ; 51(3): 211-216, jul.-set. 2018.
Article in Portuguese | LILACS | ID: biblio-979801


A poliangiite microscópica (PAM) é uma vasculite necrosante sistêmica pauci-imune associada ao anticorpo anticitoplasma de neutrófilos (ANCA) com preferência de pequenos vasos. Relato do caso: Relatamos o caso de uma paciente do sexo feminino, 54 anos, que apresentou quadro de poliartrite migratória em punhos, joelhos e tornozelos associada à rigidez matinal progressiva, com histórico de "rash" malar, fotossensibilidade e alopecia. Progrediu ao longo do ano de 2017 com deterioração da função renal e hemorragia pulmonar, necessitando de cuidados intensivos. A biópsia renal sugeriu padrão compatível com glomerulonefrite pauci-imune e o diagnóstico de poliangiite microscópica foi aventado. Realizou pulsoterapia com metilprednisolona e ciclofosfamida, além de plasmaférese, recebendo alta após estabilização do quadro clínico. Importância do problema: O presente caso ilustra uma complicação incomum e de elevada morbimortalidade da PAM. A negatividade do ANCA dificultou o diagnóstico, sendo necessária a realização de biópsia renal com confirmação diagnóstica. A síndrome pulmão-rim apresenta evolução potencialmente fatal se não instituído precocemente o tratamento. (AU)

Microscopic polyangiitis (MPA) is a pauci-immune systemic necrotizing vasculitis associated with neutrophil anti-cytoplasmic antibody (ANCA) with a preference for small vessels. Case report: We report the case of a 54-year-old woman, who presented migratory polyarthritis in wrists, knees and ankles associated with progressive morning stiffness, with history of malar "rash", photosensitivity and alopecia. It progressed throughout the year of 2017 with deterioration of renal function and pulmonary hemorrhage, requiring intensive care. Renal biopsy suggested a pattern compatible with pauci-immune glomerulonephritis and the diagnosis of microscopic polyangiitis was suggested. She underwent pulse therapy with methylprednisolone and cyclophosphamide, in addition to plasmapheresis, being discharged from hospital after stabilization of the clinical condition. Importance of the issue: The present case reveals an uncommon and high morbimortality complication of MPA. The negativity of the ANCA made diagnosis difficult, and a renal biopsy was necessary to confirm diagnosis. Lung-kidney syndrome is potentially fatal if the treatment is not instituted early. (AU)

Humans , Female , Middle Aged , Pulmonary Alveoli , Microscopic Polyangiitis , Glomerulonephritis , Hemorrhage , Hemothorax
Rev. Soc. Bras. Med. Trop ; 51(4): 479-484, July-Aug. 2018. tab
Article in English | LILACS | ID: biblio-957451


Abstract INTRODUCTION: In many settings, the lack of sensitive biomarkers of disseminated histoplasmosis (DH) leads to a clinical reliance on older diagnostic methods and delayed treatment initiation. The early recognition of DH is critical for survival, especially in patients with human immunodeficiency virus (HIV). This study aimed to identify clinical and laboratory findings associated with the definitive diagnosis of DH in low-income HIV patients in endemic areas. METHODS: Febrile AIDS patients with suspected DH who were admitted to a reference hospital in northeastern Brazil from January 2006 to January 2007 were evaluated for clinical and laboratory findings associated with DH diagnosis. RESULTS: One hundred seventeen patients with fever were included, and 48 (41%) cases of DH were determined by Histoplasma capsulatum identification. A higher fever (≥38.5ºC), maculopapular/papular rash, splenomegaly, hepatomegaly, wheezing, hemoglobin ≤9.5g/dL, platelets ≤80,000/µL, CD4 count ≤75/µL, aspartate aminotransferase (AST) level ≥2.5 times the upper limit of normal (ULN), lactate dehydrogenase (LDH) ≥5times the ULN; and international normalized ratio (INR) >2 times the ULN were significantly associated with DH. A multivariable analysis identified hepatomegaly [adjusted (a) prevalence ratio (PR)= 1.96; 95% confidence interval (CI): 1.21-3.16), CD4 count ≤75/µL (aPR = 2.02; 95% CI: 1.06-3.83), LDH ≥5 times the ULN (aPR = 2.23; 95% CI: 1.44-3.48), and maculopapular/papular rash (aPR = 1.70; 95% CI: 1.02-2.83) were independent risk factors for DH. CONCLUSIONS: These easily assessed parameters can facilitate clinical decision-making for febrile AIDS patients with suspected DH in low socioeconomic and Histoplasma-endemic regions.

Humans , Male , Female , Adolescent , Adult , Young Adult , AIDS-Related Opportunistic Infections/diagnosis , Fever/microbiology , Histoplasma/isolation & purification , Histoplasmosis/diagnosis , Socioeconomic Factors , Brazil/epidemiology , Prevalence , Prospective Studies , Risk Factors , AIDS-Related Opportunistic Infections/epidemiology , CD4 Lymphocyte Count , Histoplasmosis/epidemiology , Middle Aged
J. Health Biol. Sci. (Online) ; 6(1): 108-112, jan-mar.2018. tab, ilus
Article in English | LILACS | ID: biblio-876376


Introduction: Whipple's disease is a rare, infectious disease caused by the bacterium Tropheryma whipplei that affects multiple organs and systems. It is difficult to identifyand frequently presents as a diagnosis of exclusion due existence of conditions causing most prevalent chronic diarrhea, as AIDS and Inflammatory Bowel Disease. Case report: Herein we report the clinical findings of a 38-year-old male patient, married with a HIV seropositive woman, with a four-year course of chronic diarrhea until he received a definitive diagnosis. Treatment was started with a 15-day penicillin G regimen, followed by continued trimethoprim­sulfamethoxazole 80/400mg after hospital discharge up to current days. Conclusion: Currently, the patient remains asymptomatic and has completed clinical remission after two years of treatment. (AU)

Introdução: A doença de Whipple é uma doença infecciosa rara causada pela bactéria Tropheryma whipplei que afeta múltiplos órgãos e sistemas. É difícil de identificar e freqüentemente se apresenta como um diagnóstico de exclusão devido à existência de condições que causam diarréia crônica mais prevalentes, como AIDS e Doença Infçamatória Intestinal. Relato do Caso: Aqui, relatamos os achados clínicos de um paciente do sexo masculino de 38 anos, casado com uma mulher HIV-soropositiva, com um curso de quatro anos de diarréia crônica até receber o diagnóstico definitivo. O tratamento foi iniciado com penicilina G por 15 dias, seguido de sulfametoxazol- trimetoprim 400/80 mg após a alta hospitalar até os dias atuais. Conclusão: Atualmente, o paciente permanece assintomático e apresentado remissão clínica completa após dois anos de tratamento. (AU)

Whipple Disease , Arthritis , Diarrhea