Hepatitis A and hepatitis E virus co-infection with right pleural effusion, ascites and acute acalculous cholecystitis. A case report / Coinfección por el virus de la hepatitis A y la hepatitis E con derrame pleural derecho, ascitis y colecistitis acalculosa aguda. Reporte de caso

ABSTRACT Hepatitis A and hepatitis E are the leading causes of acute viral hepatitis in developing countries due to our poor sanitary conditions, both spread by fecal-oral route or through contaminated water and food. Being both self-limiting diseases, they are usually benign but may present with atypical clinical findings. A 32 year-old female with right pleural effusion, ascites and acalculous cholecystitis during the course of HAV and HEV co-infection is reported. Clinical improvement was observed with conservative management. As far as we know, this is the first case described of a patient with these three complications in the background of a hepatitis A virus and hepatitis E virus co-infection.

RESUMEN Hepatits A y hepatitis E son las principales causas de hepatitis viral en países en desarrollo debido a las limitadas condiciones sanitarias. Son condiciones usualmente benignas y autolimitadas, pero pueden presentarse de forma atípica. Se reporta una paciente de 32 años con efusión pleural derecha, colecistitis acalculosa y ascitis en el curso de una co-infección por el virus de Hepatitis A y hepatitis E. Hasta donde tenemos conocimiento, este es el primer caso de una paciente con estas tres complicaciones como resultado de una infección por el virus de hepatitis A y hepatitis E.

Necrolytic acral erythema in a Chinese patient with hepatitis C and hepatitis B virus coinfection

Abstract: Necrolytic acral erythema is a distinct erythema that has been described as an extrahepatic manifestation of hepatitis C virus infection. Most reported cases have been in Africa, especially Egypt. We report the first case (to the best of our knowledge) of necrolytic acral erythema in a Chinese patient with HCV and HBV coinfection. We aim to increase awareness for recognizing this condition in the Chinese population.

Hiperinfección por Strongyloides en paciente de la Patagonia con co-infección por HTLV-1 / Strongyloides hyperinfection in patient from Patagonia with HTLV-1 co-infection

La estrongiloidiasis es una afección desatendida causada por el parásito Strongyloides stercoralis. En los individuos inmunosuprimidos, fundamentalmente en los que tienen depresión de la inmunidad celular, puede desarrollarse el síndrome de hiperinfección por Strongyloides. La coinfección con virus linfotrópico de células T humanas (HTLV) es un factor de riesgo para el desarrollo de formas graves de estrongiloidiasis. Presentamos el caso de un hombre de 50 años con hiperinfección por Strongyloides y coinfección con HTLV. Se demoró el diagnóstico debido a su epidemiología inusual y a la sospecha inicial de enfermedad inflamatoria intestinal. El diagnóstico se confirmó mediante la identificación del parásito en muestras de lavado bronquio-alveolar y biopsias de mucosa duodenal y colónica. Se utilizó ivermectina subcutánea como tratamiento antihelmíntico con adecuada respuesta terapéutica.

Strongylodiasis is an unattended condition caused by the parasite Strongyloides stercoralis. The Strongyloides hyperinfection syndrome can develop in immunosuppressed hosts, mainly in those with depression of cellular immunity. Co-infection with human T-cell lymphotropic virus (HTLV) is a risk factor for the development of severe forms of strongyloidiasis. We present the case of a 50-year-old man with Strongyloides hyperinfection and coinfection with HTLV. The diagnosis was delayed owing to its unusual epidemiology and an initial suspicion of inflammatory bowel disease. Identification of the parasite in bronchioalveolar lavage and duodenal and colonic mucosa biopsies confirmed the diagnosis. Subcutaneous ivermectin was used as an anthelmintic treatment with an adequate therapeutic response.

Leprosy and American cutaneous leishmaniasis coinfection

Abstract: Brazil is a country with a high prevalence of infectious diseases such as leprosy and leishmaniasis. However, coinfection of these diseases is still poorly understood. We report a case of a patient who presented with lepromatous leprosy and cutaneous-mucosal leishmaniasis at the same period. After clinical, laboratory, and histopathological diagnosis, the treatment was introduced and the patient showed important clinical improvement. He was followed in our outpatient clinic. Both pathologies play an important role in the immune system. Depending on the immune response profile of the host, diseases may present themselves in different ways. In this case, the patient showed a divergent immune response for each disease. We hypothesized that this response is specific for each pathogen.

Desafios no diagnóstico da infecção pelos Vírus Linfotrópicos de Células T Humanas do tipo 1 e tipo 2 (HTLV-1 e HTLV-2) em pacientes infectados com o HIV-1 / Challenges in the diagnosis of Human T-Cell Lymphotropic Virus type 1 and type 2 (HTLV-1 and HTLV-2) infection in patients infected with HIV-1

Desde a década de 90 o Instituto Adolfo Lutz de São Paulo (IAL) tem realizado o diagnóstico da infecção por Vírus Linfotrópicos de Células T Humanas dos tipos 1 e 2 (HTLV-1 e HTLV-2) e, desde então, têm sido reportadas as dificuldades principalmente no diagnóstico de HTLV-2, em especial em pacientes infectados pelo HIV-1. O presente trabalho teve como objetivo avaliar várias técnicas de diagnóstico disponíveis no momento atual (kits comerciais e testes in house) e estabelecer o melhor algoritmo para ser empregado no diagnóstico de pacientes infectados pelo HIV-1. A população analisada foi composta por dois grupos provenientes de Serviços de Assistência Especializados em HIV/AIDS de São Paulo: um pioneiro [Grupo 1 (G1), n=1.608] e outro com histórico mais recente [Grupo 2 (G2), n=1.383]. Ambos os grupos foram formados, na maioria, por indivíduos do sexo masculino... (AU).

Since the 90 decade, the Instituto Adolfo Lutz (IAL) has performed the diagnosis of Human T-cell Lymphotropic Virus type 1 and type 2 (HTLV-1 and HTLV-2), and thenceforth the difficulties in diagnosing HTLV-2 have been reported, mostly in HIV-infected patients. The present study aimed at evaluating the several diagnostic techniques currently available (commercial kits and in-house assays), and to establish the best algorithm to be employed for diagnosing HTLV-1/-2 in patients infected with HIV-1. The study population was composed by two patient groups attended at HIV/AIDS specialized services care in São Paulo: the pioneer one [Group 1 (G1), n=1,608], and the other with the most recent historical health setting [Group 2 (G2), n=1,383. The majority of the both groups were composed by male patients...(AU).

Hepatic peroxisome proliferator-activated receptor γ and α-mRNA expression in HCV-infected adults is decreased by HIV co-infection and is also affected by ethnicity

OBJECTIVE: To determine peroxisome proliferator activated receptor α and γ mRNA expression in liver tissue of hepatitis C virus-infected patients with and without human immunodeficiency virus and its possible contribution to an acceleration of liver disease progression. METHODS: We measured peroxisome proliferator-activated receptor α and γ mRNA expression by real-time polymerase chain reaction in liver tissues from 40 subjects infected only with hepatitis C virus, 36 subjects co-infected with hepatitis C virus and human immunodeficiency virus and 11 normal adults. RESULTS: Hepatic mRNA expression of both peroxisome proliferator-activated receptors was significantly lower in hepatitis C virus-infected subjects with and without human immunodeficiency virus co-infection compared to the controls. Non-black race was also identified as a predictor of lower peroxisome receptor α and γ mRNA expression. Compared to subjects infected only with hepatitis C virus, liver peroxisome receptor γ mRNA expression was significantly lower in hepatitis C virus/human immunodeficiency virus-co-infected subjects (0.0092 in hepatitis C virus/human immunodeficiency virus-co-infection vs. 0.0120 in hepatitis C virus-only; p=0.004). Hepatic peroxisome receptor α mRNA expression in the hepatitis C virus-infected patients was lower in the presence of human immunodeficiency virus co-infection in non-black subjects (0.0769 vs. 0.1061; p=0.02), whereas the levels did not vary based on human immunodeficiency virus status among black subjects. CONCLUSION: mRNA expression of both peroxisome proliferator-activated receptors is impaired in hepatitis C virus-infected liver and further reduced by human immunodeficiency virus co-infection, although the suppressive effects of the viruses are substantially mitigated in black patients.

Factors associated with undernourishment among people 20 years old or over with HIV/AIDS, attending public health services in the São Paulo municipality, Brazil / Factores asociados a la desnutrición en personas con 20 años o más, portadores de VIH/SIDA, en los servicios públicos de salud de la ciudad de São Paulo, Brasil / Fatores associados à desnutrição em pessoas com 20 anos e mais, com HIV/AIDS, em serviços públicos de saúde no Município de São Paulo, Brasil

The study evaluated the nutritional status of 629 people living with HIV/AIDS attended at 12 specialized services of São Paulo's Municipal Health Department, Brazil. Data were obtained from medical records and through interviews during nutritional consultation. We used the classification criteria established by World Health Organization to assess malnourished individuals, a BMI < 18.5kg/m2. The prevalence of malnutrition in people with AIDS is 3.12 times that observed among people with HIV, and among people with co-infection it is 3.41 times that obtained among people without co-infection. This indicates how these conditions can harm the maintenance of the nutritional status, and shows that they demand a comprehensive understanding of the mechanisms involved in this phenomenon, as well as the development of strategies to improve the health care of individuals at nutritional risk.

El estudio evaluó la prevalencia de la desnutrición en 629 personas con VIH/SIDA en 12 servicios especializados de la red municipal de salud de Sao Paulo, Brasil. Los datos se obtuvieron de los registros médicos y entrevistas durante la consulta nutricional. Se utilizó para definir la desnutrición el criterio de la Organización Mundial de la Salud (IMC < 18,5kg/m2). Se observó que la prevalencia de desnutrición en las personas con SIDA es 3,12 veces mayor que la observada entre las personas con VIH, y en personas con coinfección es 3,41 veces mayor que la obtenida entre las personas sin coinfección. Esto indica que estas condiciones pueden ser perjudiciales para el mantenimiento del estado nutricional, y se recomienda un estudio más profundo de los mecanismos implicados en este fenómeno, así como el desarrollo de estrategias para la atención integral en salud de las personas en situación de riesgo nutricional.

O estudo avaliou a prevalência de desnutrição de 629 pessoas com HIV/AIDS, em 12 serviços especializados da Rede Municipal de Saúde de São Paulo, Brasil. Informações foram obtidas de prontuários e em entrevistas durante consulta de nutrição. Utilizou-se, para definição de desnutrição, o critério da Organização Mundial da Saúde (IMC < 18,5kg/m2). Observou-se que a prevalência de desnutrição em pessoas com AIDS é 3,12 vezes aquela verificada entre pessoas com HIV, e, entre pessoas com coinfecção, 3,41 vezes a obtida entre pessoas sem coinfecção. Isso indica que tais condições podem ser deletérias para a manutenção do estado nutricional, sendo recomendados uma compreensão mais aprofundada dos mecanismos envolvidos nesse fenômeno e o desenvolvimento de estratégias para o cuidado integral de saúde dos indivíduos em risco nutricional.

Infección por VIH, hígado y tracto biliar: evaluación de las complicaciones en los pacientes infectados / HIV infection, liver and biliary tract. Evaluation of complications in infected patients

Liver and biliary tract disease in patients with HIV infection is common and is related to immunosuppression, therapy and coinfection with hepatitis B and/or C virus. In this way, we can observe the development of opportunistic infections or malignancies related or not to HIV, viral hepatitis, drug toxicity, multifactorial hepatic steatosis and cirrhosis. We review each one of these complications and major clinical elements for diagnosis. Finally, an algorithm for the study of the complications of the liver and biliary tract in these patients is proposed.

La enfermedad hepática y de la vía biliar en pacientes con infección por VIH es común y se relaciona con la inmunosupresión, el tratamiento y la coinfección por virus B y/o C. De esta forma, podemos observar el desarrollo de infecciones oportunistas, neoplasias relacionadas o no a VIH, hepatitis virales, toxicidad por drogas, esteatosis hepática multifactorial y cirrosis. Revisamos cada una de estas complicaciones y los elementos clínicos más importantes para su diagnóstico. Finalmente, se propone un algoritmo de estudio de las complicaciones hepáticas y de la vía biliar en estos pacientes.

Hepatitis B y C en pacientes oncológicos / Hepatitis B and C oncological patients

La mayoría de los niños que padecen enfermedades hemato-oncológicas reciben múltiples transfusiones y esto aumenta el riesgo para adquirir estas infecciones. Por otro lado, en estos niños inmunosuprimidos la infección suele ser subclínica. Suele diagnosticarse al observar elevación de aminotransferasas. Evaluar la respuesta al tratamiento de hepatitis en niños con antecedentes oncológicos. 80 pacientes con antecedentes de tratamiento hematoncológico, del año 2000 a 2008 con serologías positivas para hepatitis viral. 39 (48,75%) presentan Hepatitis B, 19 (23,75%) Hepatitis C, 22 (27,75%) coinfección Hepatitis B y C. En el grupo HBV, 7 negativizaron espontáneamente DNAHBV. 20 recibieron tratamiento con diferentes esquemas: 3 IFN, 4 lamivudina, 3 lamivudina + IFN, 10 Lamivudina + PEG; 7/20 negativizaron ADN VHB. 6/10 con tratamiento combinado negativizaron DNAHBV (60%). En el grupo con Hepatitis C, todos genotipo 1; 3 negativizaron RNAHCV espontáneamente; 10 recibieron tratamiento, 3/10 tratados con IFN + RIBAVIRINA y 7 con PEG + RIBAVIRINA. 1/3 y 4/7 (57,14%), negativizaron RNAHCV, respectivamente. En el grupo con coinfección, 14 tratados: 2 IFN; 4 IFN + RIBAVIRINA; 8 PEG + RIBAVIRINA. 11/12 con esquema combinado culminaron tratamiento; negativizaron 1/11 (9%) DNAHBV y 5/11 (45,45%) RNAHCV. 8/80 desarrollaron complicaciones, cirrosis y hepatocarcinoma. Los pacientes pediátricos presentan respuesta al tratamiento para hepatitis B y C crónicas, similar al del adulto. Hubo diferencia estadísticamente significativa en la respuesta al tratamiento relacionado con el grado de inflamación en pacientes coinfectados. Cirrosis y hepatocarcinoma también se presentan en este grupo de edad...

Most children with hemato-oncological diseases receive multiple transfusions, and this increases the risk of acquiring these infections. On the other hand, in these immunosuppressed children the infection is usually subclinical. It’s usually diagnosed by observing an elevation in aminotransferases figures. To evaluate the response to the treatment for hepatitis in children with a history of cancer. 80 patients with a history of hemato-oncological treatment, from 2000 to 2008, with positive viral hepatitis serologies/for viral hepatitis. 39 (48,75%) had Hepatitis B, 19 (23,75%) Hepatitis C, 22 (27,75%) coinfection Hepatitis B and C. In the HBV group, 7 had spontaneous HBV-DNA negative, 20 received treatment with different schemes: 3 IFN, 4 lamivudine, 3 lamivudine + IFN, 10 lamivudine + PEG; 7/20 had HBV-DNA negative. 6/10 with combined treatment had HBV-DNA negative (60%). In the group with Hepatitis C, all genotype 1; 3 had spontaneous HCV-RNA negative; 10 received treatment, of which 3/10 were treated with IFN + RIBAVIRIN and 7 with PEG + RIBAVIRIN. 1/3 and 4/7 (57.14%) had HCV-RNA negative, respectively. In the group with HBV/HCV co-infection, 14 patients treated: 2 IFN, 4 IFN + RIBAVIRIN, 8 PEG + RIBAVIRIN. 11/12 with combined scheme ended treatment; 1/11 (9%) and 5/11 (45,45%) had HBV-DNA and HCV-RNA negative, respectively. 8/80 developed complications, such as, cirrhosis and hepatocellular carcinoma. Pediatric patients presented similar response to adult patients, to the treatment for chronic hepatitis B and C. There was a statistically significant difference in treatment response related to the degree of inflammation in coinfected patients. Cirrhosis and hepatocellular carcinoma are also evidenced in this age group...