Aspectos clinicoepidemiológicos e imagenológicos de pacientes con virus de inmunodeficiencia humana/sida y diagnóstico de neurotoxoplasmosis / Clinical epidemiological and imaging aspects of patients with human immunodeficiency virus/aids and diagnosis of neurotoxoplasmosis i: en

Introducción: El síndrome de inmunodeficiencia adquirida es el estadio final de una enfermedad crónica, transmisible y progresiva de causa viral. La neurotoxoplasmosis es la infección oportunista más frecuente en pacientes inmunodeprimidos. Objetivo: Caracterizar a los pacientes con neurotoxoplasmosis secundaria al virus de inmunodeficiencia humana/sida según variables epidemiológicas, clínicas e imagenológicas. Métodos: Se efectuó un estudio observacional, descriptivo y transversal de 18 pacientes con sida, quienes recibieron diagnóstico clínico y microbiológico de neurotoxoplasmosis, caracterizados según hallazgos en la resonancia magnética por imágenes antes y después del tratamiento, desde enero de 2017 hasta diciembre de 2019. Resultados: En la investigación primaron el sexo masculino, las edades de 34 o menos años (66,7 %) y las manifestaciones clínicas de fiebre (100,0 %) y cefalea (88,9 %). La localización más habitual de las lesiones fue en la unión cortico-subcortical (66,1 %). Resultaron más frecuentes las imágenes hipointensas en T1 y en recuperación de la inversión atenuada de fluido y las imágenes hiperintensas en T2; se destacaron las lesiones múltiples (66,7 %), de pequeño tamaño (50,0 %) y los contornos irregulares (88,9 %). Antes del tratamiento tuvieron mayor frecuencia el realce de tipo anular (72,2 %) y el edema vasogénico de grado 2 (50,0 %); después de este, 55,6 % de los afectados presentaron calcificaciones y 72,2 % hemorragia intralesional. Se evidenció que 77,8 % tuvieron mejoría con respecto al edema cerebral. Conclusiones: La resonancia magnética por imágenes permitió caracterizar a los pacientes con virus de inmunodeficiencia humana/sida y toxoplasmosis cerebral, así como evaluar la respuesta terapéutica a través de las modificaciones en los hallazgos imagenológicos.

Introduction: The acquired immunodeficiency syndrome is the final stage of a chronic, communicable and progressive disease of viral cause. The neurotoxoplasmosis is the most frequent opportunist infection in immunodepressed patients. Objective: To characterize patients with secondary neurotoxoplasmosis to human immunodeficiency virus/aids according to epidemiological, clinical and imaging variables. Methods: An observational, descriptive and cross-sectional study of 18 patients with AIDS was carried out, who received clinical and microbiological diagnosis of neurotoxoplasmosis, characterized according to findings in the magnetic resonance by images before and after the treatment, from January, 2017 to December, 2019. Results: In the investigation there was a prevalence of the male sex, the ages of 34 or less years (66.7 %) and the clinical signs of fever (100.0 %) and headache (88.9 %). The most common localization of the lesions was in the cortico-subcortical juntion (66.1 %). The hypointense images in T1 and fluid attenuated inversion recovery and hyperintense images in T2 were the most frequent; the multiple lesions (66.7 %) of small size (50.0 %) and irregular contours (88.9 %) were notable. Before the treatment the enhance of anular type had more frequency (72.2 %) and grade 2 vasogenic edema (50.0 %); after this, 55.6 % of those affected persons presented calcifications and 72.2 % intralesional hemorrhages. It was evidenced that 77.8 % had improvement respect the cerebral edema. Conclusions: The magnetic resonance by images allowed to characterize the patients with human immunodeficiency virus/aids and cerebral toxoplasmosis, as well as to evaluate the therapeutic response through the modifications in the imaging findings.

Síntomas faríngeos como primera manifestación clínica en un paciente con Histoplasmosis generalizada / Pharyngeal symptoms as first clinical manifestation in a patient with Generalized Histoplasmosis

Introducción: La Histoplasmosis es una enfermedad endémica, que presenta un comportamiento oportunista cuyo germen causal es el Histoplasma capsulatum (HC), considerado un hongo dimórfico. Objetivo: Presentar un caso con el diagnóstico de Histoplasmosis generalizada, cuyas manifestaciones faríngeas fueron el inicio de la enfermedad. Presentación del caso: Se presenta el caso de un paciente, con los síntomas faríngeos que fueron la primera manifestación de la enfermedad, en el que la biopsia permitió llegar al diagnóstico nosológico. Posteriormente presentó otras manifestaciones con aspectos clínicos-microbiológicos de diseminación progresiva. Conclusiones: La Histoplasmosis faríngea es una micosis sistémica infrecuente y de difícil diagnóstico, es preciso un buen interrogatorio y examen físico, en aquellos pacientes con factores de riesgo de enfermedades infecciosas sin diagnóstico aparente y deterioro progresivo de su estado general(AU)

Introduction: The Histoplasmosis is an endemic illness that presents an opportunist behavior in which causal germ is the Histoplasma capsulatum (HC), considered a dimorphic mushroom. Objective: To present a case with the diagnosis of Generalized Histoplasmosis in which pharyngeal manifestations were the beginning of the illness. Presentation of the case: The case of a patient is presented with the pharyngeal symptoms that were the first manifestation of the illness, in which the biopsy allowed to arrive to the diagnostic. Later the patient presented other manifestations with clinical-microbiologic aspects of progressive dissemination. Conclusions: The pharyngeal Histoplasmosis is an uncommon systemic mycosis and with a difficult diagnostic, it is necessary a good interrogation and physical exam, in those patients with factors of risk of infectious illnesses without apparent diagnosis and progressive deterioration of their general state(AU)

Oral lesions frequency in HIV-positive patients at a tertiary hospital, Southern Brazil

AIM: To report the frequency of oral lesions in HIV-positive patients on Highly Active Antiretroviral Therapy (HAART), comparing with a non-HIV infected control group, and to correlate the presence of lesions with demographic and clinical features of HIV-seropositive patients. METHODS: A quantitative case-control study was conducted by a dental professional, using a questionnaire, analysis of medical records of patients and clinical examinations. RESULTS: According to the results, oral lesions were found in 23% of HIV-positive patients versus 5% in controls. Candidiasis (29%) and periodontal changes (25%) were the most frequent oral lesions found in these patients. Gender and viral load values were statistically significant when HIV-positive patients with and without oral lesions were compared. CONCLUSIONS: The results showed a change in lesion pattern of HIV patients on HAART, highlighting a high frequency of these new lesions and reinforcing the need for periodic dental evaluation of HIV-positive patients.

Activity of antiretroviral drugs in human infections by opportunistic agents

Highly active antiretroviral therapy (HAART) is used in patients infected with HIV. This treatment has been shown to significantly decrease opportunist infections such as those caused by viruses, fungi and particularly, protozoa. The use of HAART in HIV-positive persons is associated with immune reconstitution as well as decreased prevalence of oral candidiasis and candidal carriage. Antiretroviral therapy benefits patients who are co-infected by the human immunodeficiency virus (HIV), human herpes virus 8 (HHV-8), Epstein-Barr virus, hepatitis B virus (HBV), parvovirus B19 and cytomegalovirus (CMV). HAART has also led to a significant reduction in the incidence, and the modification of characteristics, of bacteremia by etiological agents such as Staphylococcus aureus, coagulase negative staphylococcus, non-typhoid species of Salmonella, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Mycobacterium tuberculosis. HAART can modify the natural history of cryptosporidiosis and microsporidiosis, and restore mucosal immunity, leading to the eradication of Cryptosporidium parvum. A similar restoration of immune response occurs in infections by Toxoplasma gondii. The decline in the incidence of visceral leishmaniasis/HIV co-infection can be observed after the introduction of protease inhibitor therapy. Current findings are highly relevant for clinical medicine and may serve to reduce the number of prescribed drugs thereby improving the quality of life of patients with opportunistic diseases.

A terapia HAART (terapia antirretroviral altamente ativa) é usada em pacientes infectados pelo vírus da imunodeficiência humana (HIV) e demonstrou diminuição significativa de infecções oportunistas, tais como as causadas por vírus, fungos, protozoários e bactérias. O uso da HAART está associado com a reconstituição imunológica e diminuição na prevalência de candidíase oral. A terapia antirretroviral beneficia pacientes co-infectados pelo HIV, vírus herpes humano 8 (HHV-8), vírus Epstein-Barr (EBV), vírus da hepatite B (HBV), parvovírus B19 e citomegalovírus (CMV). A HAART também apresentou redução significativa da incidência e modificou as características da bacteremia por agentes etiológicos, tais como Staphylococcus aureus, espécies não-tifóides de Salmonella, Streptococcus pneumoniae, Pseudomonas aeruginosa, Mycobacterium tuberculosis. A HAART é capaz de modificar significativamente a história natural da criptosporidiose e microsporidiose. HAART pode efetivamente restaurar a imunidade da mucosa, levando à erradicação de Cryptosporidium parvum. Semelhante restauração da resposta imune ocorre em infecções por Toxoplasma gondii. O declínio na incidência de co-infecção leishmaniose visceral/HIV pode ser observada após a introdução da terapia com inibidores da protease. Os resultados atuais são altamente relevantes para a medicina clínica e podem proporcionar diminuição no número de prescrições medicamentosas e, consequentemente, melhor qualidade de vida para pacientes com doenças oportunistas.

Infecções oportunistas em indivíduos com infecção pelo HIV e relação com uso de terapia antirretroviral / Opportunistic infections in individuals with HIV infection and relationship with the use of anti-retroviral therapy

O uso da terapia antirretroviral e a generalização das profilaxias primária e secundária levaram à redução do número de infecções oportunistas. É fato estabelecido a relação entre a não-adesão ao tratamento antirretroviral e o desenvolvimento de resistência do vírus HIV. Este trabalho avaliou a ocorrência de infecções oportunistas em pacientes HIV, relacionado-as ao uso regular/irregular de terapia antirretroviral. Foram realizadas avaliação clínica e consulta a prontuários e laudos de exames para identificação de infecções oportunistas e foi aplicado um questionário para se avaliar o uso de medicamentos antirretrovirais. Foram avaliados 144 pacientes, 131 apresentaram infecções oportunistas antes do início da terapia HAART e 74, mesmo após terapia HAART com um episódio de infecção oportunista em 44 (59,45%) pacientes em que 34 (45,95%) alegaram uso irregular dos antirretrovirais e dez (13,5%), uso regular. Dois episódios de infecções oportunistas em 26 (35,14%) pacientes, 21 (28,38%) com uso irregular de antirretrovirais e cinco (6,76%) com uso regular e três episódios de infecções oportunistas em quatro pacientes (5,41%), três (4,05%), com uso irregular da terapia e um (1,35%), com uso regular. Assim, como é observado nas demais regiões do Brasil, houve diminuição da incidência de infecções oportunistas com a utilização da terapia HAART. Por outro lado, continuam novos casos de infecções oportunistas, sugerindo que algumas pessoas têm esgotado todas as possibilidades quanto às terapias disponíveis

The use of HAART therapy and the spread of primary and secondary prophylaxis led to a reduction in the number of opportunistic infections. The relationship between non-adherence to antiretroviral therapy and the development of resistance of the HIV virus is an established fact. This study evaluated the incidence of opportunistic infections in HIV patients and related them to the regular/irregular use of non-anti-retroviral therapy. Clinical evaluations were made and medical reports and tests consulted to detect opportunistic infections and a questionnaire was applied to evaluate the use of antiretroviral drugs. A questionnaire was applied for socioeconomic and clinical evaluation for the diagnosis of opportunistic infection. We evaluated 144 patients, 131 had opportunistic infections before the HAART therapy and 74 even after HAART therapy with an episode of opportunistic infection in 44 (59.45%) patients where 34 (45.95%) alleged irregular anti ? retroviral use and 10 (13.5%), regular use. There were two episodes of opportunistic infections in 26 (35.14%) patients, 21 (28.38%) with irregular use of antiretrovirals and five (6.76%) with regular use and three episodes of opportunistic infections in four patients (5, 41%), three (4.05%) with irregular use of therapy and one (1.35%) with regular use. As is observed in other regions of Brazil, the incidence of opportunistic infections decreased with the use of HAART therapy. On the other hand, there continue to be new cases of opportunistic infections, suggesting that some people have exhausted all possibilities as to available therapies

Infección por el virus de la inmunodeficiencia humana (VIH) en servicios de medicina / Human Immunodeficiency Virus (HIV) infection in medical services

Para determinar la morbimortalidad por el virus de inmunodeficiencia humana (VIH) en los servicios de medicina del Hospital “Ruiz y Páez” de Ciudad Bolívar, estado Bolívar, Venezuela. Durante el año 2005, se realizó un estudio prospectivo, descriptivo, serie de casos de los pacientes VIH positivos. Se estudiaron 53 pacientes adultos. La recolección de los datos se llevó a cabo mediante una ficha de registro. En promedio ingresaron mensualmente 4,4 casos de infección por VIH; el grupo etario en edad productiva (22 a 31 años) y el sexo masculino fueron los más frecuentes. Predominó el uso de drogas no parenterales como un factor de riesgo indirecto asociado a la adquisición del VIH por condicionar conductas que culminan en practicas sexuales no seguras con 26,4% (n =14). Resaltaron la fiebre y pérdida de peso como los síntomas mas frecuentes; el tubo digestivo y sistema nervioso central fueron los órganos mas afectados. Infección urinaria, candidiasis orofaríngea y parasitosis intestinal fueron las infecciones asociadas más frecuentes. La proporción de casos para la serie estudiada fue de 0,087 y la tasa de letalidad anual de 13,2 % (n = 7 defunciones).

We carried out a descriptive prospective study in a series of cases of HIV positive patients to determine the morbid-mortality rates due to human immunodeficiency virus (HIV) at the medical services of the Hospital “Ruiz y Paez” in Ciudad Bolivar, Bolivar State, Venezuela, during the year 2005. We studied 53 adult patients. Data were collected through a registration form. We registered the entrance of an average of 4.4 cases of HIV infections per month; the productive age group (22-31 years) and the male sex were the most frequent. The use of non parenteral drugs predominated as indirect risk factor associated to the acquisition of the HIV infection because it conditions conducts that culminate in unsafe sexual practices in 26.4% (n=14) cases. Fever and weight loss appeared as the most frequent symptoms; the digestive tube and the central nervous system appeared as the most affected organs, Urinary infections, oropharingeal candidiasis and intestinal parasitosis were the most frequent associated infections. The proportion of cases studied for the series was 0.087 and the annual mortality rate was 13.2% (n=7 deaths).

Frecuencia y distribución de las infecciones oportunistas en pacientes adultos con vih/sida en el hospital de Infectología de Guayaquil, enero a junio de 2005 / Frequency and distribution of opportunist infections in adult hiv/aids patients in Guayaquil Infectiology hospital, january to june/2005

No existe duda que en la actualidad el Síndrome de Inmunodeficiencia Adquirida (SIDA) es una de las más grandes amenazas en el ámbito de la salud mundial, con tres millones de muertes por año; en el mundo es la cuarta causa de mortalidad general y la primera por enfermedades infecciosas. Objetivo: conocer la frecuencia de las infecciones oportunistas; distribución por edad y sexo; la sintomatología en el momento de ingreso, por patología. Materiales y métodos: estudio retrospectivo de tipo transversal, descriptivo; universo de 215 pacientes que ingresaron al hospital de Infectología de Guayaquil, área de emergencia, enero a junio de 2005; se analizaron las historias clínicas de una muestra de 122 pacientes. Las variables fueron: edad, sexo, tiempo de evolución de VIH, tipo de infección oportunista, síntomas. Resultados: el sexo más afectado fue el masculino (76 y 24 respectivamente); la mayor parte de los pacientes eran menores de treinta años (42). La sintomatología más frecuente al ingreso fue la fiebre (24) y la infección oportunista de mayor ocurrencia fue la tuberculosis (42). La sintomatología respiratoria predominó en los pacientes con tuberculosis e histoplasmosis; las manifestaciones digestivas en la criptosporidiosis y colitis amebiana, y las neurológicas fueron característica de la toxoplasmosis y criptococosis. Conclusiones: se demuestra que en nuestro medio la tuberculosis es la infección oportunista más frecuente en los pacientes adultos con VIH/SIDA y que la manifestación clínica más común para ésta es la fiebre.

No doubt in present days, Acquired Immune Deficiency Syndrome (AIDS) is one of the biggest threatens in the world health realm, with three million deaths per year; it is the fourth cause of general mortality in the world, and the first one due to infectious deseases. Objective: to know the frequency of opportunist infections; age and sex distribution; symptoms at admission, by pathology. Materials and methodes: retrospective study, transversal type, descriptive; universe of 215 patients admitted in Guayaquil Ifectiology hospital, emergency area, from January to June/2005; the clinical records of a sample of 122 patients were checked. The variables were: age, sex, HIV evolution time, opportunist infection type, symptoms. Results: males were more affected (76 - M vs. 24- F); most of patients were younger than 30 years old (42). Most frequent symptoms at admission were fever (24), and the most frequent opportunist infection was tuberculosis (42). Respiratory symptoms predominated in tuberculosis and histoplasmosis patients; digestive signs in criptosporidiosis and amebic colitis, and neurologic signs were toxoplasmosis and criptococosis characteristics. Conclusions: it is proved that, in our environment, tuberculosis is the most frequent opportunist infection in adult HIV/AIDS patients and its most common sign is fever.

Adesão ao tratamento/profilaxia de tuberculose associada à infecção HIV/AIDS no Centro de Treinamento e Referência em Doenças Infecciosas e Parasitárias Orestes Diniz / Compliance to treatment/prophylaxis of tuberculosis associated to HIV/Aids at the Orestes Diniz infectious and parasite disease training and reference center / Adhesión al tratamiento/profilaxia de la tuberculosis asociada a la infección HIV/Aids en el centro de entrenamiento y referencia en enfermedades infecciosas y parasitarias Orestes Diniz

Este estudo discute a adesão ao tratamento e profilaxia de tuberculose em pacientes do Centro de Treinamento e Referência em Doenças Infecciosas e Parasitárias. Foram levantados dados de 368 casos registrados no período de janeiro de 1998 a janeiro de 2001. Desses, 318 referiam-se à associação tuberculose/HIV, sendo 72,9% de casos registrados como tratamento e 27,1% como profilaxia. Observou-se que 140 casos (38%) abandonaram o tratamento e somente 163 (44,2%) obtiveram alta por cura. O alto percentual de abandono sinaliza falhas no serviço, indicador que também aponta para a complexidade da adesão ao tratamento/profilaxia de tuberculose dos portadores de HIV/Aids

This study discusses the compliance of patients to treatment and prophylaxis of tuberculosis in the Training and Reference Center for Infectious and Parasite Diseases. Data was collected from 368 cases recorded from January 1998 to January 2001. Of these, 318 had the association of tuberculosis/HIV, of which 72,9% were for treatment and 27,1% for prophylaxis. 140 cases (38%) abandoned treatment and only 163 (44,2%) were discharged after healing. The high percentage of abandonment indicates faults in the service, which also shows the complexity of compliance to treatment prophylaxis of tuberculosis of HIV/AIDS infected patients

Este estudio discute la adhesión al tratamiento y profilaxis de la tuberculosis en los pacientes del Centro de Entrenamiento y Referencia en Enfermedades Infecciosas y Parasitarias. Se levantaron datos de 368 casos registrados entre enero de 1998 y enero de 2001. 318 casos se referían a la asociación tuberculosis/virus VIH. De este número, el 72% de los casos fueron casos registrados como tratamiento y el 27,1% como profilaxis. Se observó que 140 casos (el 38%) abandonaron el tratamiento y solamente 163 (44,2%) fueron dados de alta. El considerable porcentaje de abandono indica fallas en el servicio y también muestra la complejidad de la adhesión de los portadores del VIH/Sida al tratamiento/profilaxis de la tuberculosis