Ascariasis complicada en un infante / Complicated ascariasis in an infant

Introducción: La ascariasis es una enteroparasitosis con alta prevalencia en la población pediátrica tercermundista, la cual puede asociarse a otras enfermedades intestinales y tener graves complicaciones que requieren tratamiento quirúrgico. Objetivo: Informar el caso de un infante operado por coinfección de ascariasis intestinal y fiebre tifoidea complicadas. Presentación del caso: Paciente masculino de 9 años de edad asistido y operado en el hospital provincial N´gola Kimbanda de la provincia Namibe, Angola, por presentar evidencia clínica de peritonitis aguda generalizada por perforación intestinal de causa tifoidea y por cuyo orificio salían además áscaris lumbricoides vivos. Su evolución no fue satisfactoria y falleció 24 horas después de la operación. Conclusiones: El diagnóstico y tratamiento quirúrgico oportuno de la coinfección letal de ascariasis y fiebre tifoidea complicadas permitirá disminuir la morbilidad y mortalidad por esta prevalente asociación(AU)

Introduction: Ascariasis is an enteroparasitosis with high prevalence in the third-world pediatric population, which can be associated with other bowel diseases and have serious complications that require surgical treatment. Objective: Report the case of an infant operated by the co-infection of complicated intestinal ascariasis and typhoid fever. Case presentation: 9-year-old male patient attended and operated at N'gola Kimbanda Provincial Hospital in Namibe Province, Angola, after presenting clinical evidence of generalized acute peritonitis due to intestinal perforation of typhoid-causing and through which live ascaris lumbricoide also came out. His evolution was unsatisfactory and he died 24 hours after the operation. Conclusions: The timely diagnosis and surgical treatment of lethal co-infection of complicated ascariasis and typhoid fever will reduce morbidity and mortality from this prevalent association(AU)

Coinfección VIH y COVID 19 en niños: teporte de casos / HIV and COVID 19 Coinfection in Children: Case Report

Honduras reportó sus dos primeros casos de COVID-19 el 11 de marzo del 2020, actualmente reporta un total de 64, 352 casos confirmados con 2,006 fallecidos que estiman una tasa letalidad de 3.1%. La presencia de comorbilidades que debiliten el sistema inmune está asociado a un incremento en la severidad y mortalidad de la enfermedad, es por esto que se ha cuestionado si la infección por virus de inmunodeficiencia humana incrementa el riesgo de contagio y severidad del cuadro de la COVID-19 debido a la presencia de bajo recuento de células CD4. En Honduras para mayo del 2020 se registraron 38,291 casos de VIH acumulados de los cuales 2,086 corresponden a menores de 14 años. En el presente reporte se incluyeron 2 pacientes pediátricos con VIH coinfectados con COVID-19 tratados en el Hospital Nacional Dr. Mario Catarino Rivas (HNMCR) desde el inicio de la pandemia en marzo hasta septiembre del 2020. Ambos pacientes fueron hospitalizados por su estado clínico crítico y la necesidad de apoyo con oxígeno. Ambos pacientes recibían terapia antirretroviral, sin embargo, el paciente numero 2 presentaba mala adherencia y se encontraba con inmunosupresión severa y falleció 2 días posteriores a su ingreso hospitalario. En conclusión, una vez más sigue siendo importante la adherencia al tratamiento antirretroviral en los niños con VIH con el fin de lograr la indetectabilidad en su carga viral mejorando su estado inmunológico, y evitando las infecciones oportunistas asociadas al VIH, así como también respondiendo adecuadamente a cualquier otra enfermedad...(AU)

Tuberculosis fatality rates in the city of Campinas - São Paulo, Brazil, from 2001 to 2009 / Taxas de letalidade por tuberculose na cidade de Campinas, São Paulo, Brasil, de 2001 a 2009

ABSTRACT: Introduction: The mortality rate among tuberculosis patients (TB fatality) has been attributed to irregular chemotherapy, delay in diagnosis, multidrug resistance, and HIV coinfection. Objective: To analyze TB fatality rates by sex, clinical presentation and HIV coinfection in Campinas, São Paulo, Brazil. Methods: Cohorts of residents in the city of Campinas who either died during treatment for tuberculosis or had the disease confirmed after death were divided into three intervals: 2001-2003, 2004-2006, and 2007-2009. Data were obtained from the database of the Tuberculosis Surveillance System of the University of Campinas, and notifications were gathered through TB-WEB Health São Paulo Secretary. Statistical significance was determined using a chi-square test, considering p < 0.05. Results: Between 2001 and 2009, 3,416 TB patients were diagnosed: 2,827 (82.8%) were new TB cases and 589 (17.2%) were retreatments. Between the first and second triennium, the number of new patients decreased by 18%, and 23% among retreatments. Between the second and third intervals, the reduction was 5% and 21%, respectively. General case fatality rate declined from 11.4% to 9.9% across intervals, and was most significant among patients that had previously abandoned treatment (17.3% to 5.1%). Fatality rates among patients coinfected with TB-AIDS were 2-3 times that of patients not infected with TB-AIDS throughout the intervals. Fatality between the first and third triennium among TB-AIDS co-infected patients declined (24.8% to 19.5%), while increasing slightly among non-AIDS TB patients (7.3% to 8%) during this period. Conclusion: Though mortality among TB-AIDS patients declined from 2001-2009, rates among non-AIDS TB remained stagnant. Improved TB diagnosis and treatment is needed to further decrease TB mortality in Campinas.

RESUMO: Introdução: A letalidade por tuberculose tem sido atribuída à quimioterapia irregular, à demora no diagnóstico, à multidrogarresistência, à coinfecção com o vírus da imunodeficiência humana (HIV). Objetivo: Analisar letalidade por tuberculose segundo sexo, apresentação clínica, presença da coinfecção pelo HIV, em Campinas, São Paulo, Brasil. Metodologia: Foram verificadas coortes de residentes em Campinas que morreram durante tratamento para tuberculose e aqueles notificados após óbito, agrupados em três intervalos: 2001-2003, 2004-2006 e 2007-2009. As informações foram obtidas no Banco de Dados para Vigilância da Tuberculose da Universidade Estadual de Campinas (UNICAMP), com captação das notificações no Sistema de Notificação e Acompanhamento de Casos de Tuberculose da Secretaria Estadual de Saúde de São Paulo. A significância estatística foi verificada pelo teste χ2 considerando p < 0,05. Resultados: Entre 2001 e 2009, foram diagnosticados 3.416 pacientes com tuberculose: 2.827 (82,8%) sem tratamento anterior e 589 (17,2%) com retratamentos. Entre o primeiro e o segundo triênio, o número de pacientes novos diminuiu 18% sem tratamento anterior e 23% entre retratamentos. Entre o segundo e o terceiro intervalo, a redução foi de 5 e 21%, respectivamente. A letalidade geral declinou de 11,4 para 9,9%, diferença mais significante entre os que haviam abandonado tratamento anteriormente (17,3 para 5,1%). A letalidade entre pacientes com coinfecção tuberculose-síndrome da imunodeficiência adquirida (Aids) foi 2-3 vezes maior que entre tuberculose sem aids durante todo o período estudado. A letalidade entre o primeiro e o terceiro triênio declinou no grupo com tuberculose-aids (24,8 para 19,5%), enquanto teve ligeiro aumento entre tuberculose sem aids (7,3 para 8%). Conclusão: Embora a mortalidade entre pacientes com tuberculose-aids tenha diminuído de 2001-2009, as taxas no grupo tuberculose sem aids permaneceram estagnadas. Melhorias no diagnóstico e no tratamento são necessárias para a redução da mortalidade entre pacientes com tuberculose em Campinas.

Predictors of mortality among intensive care unit patients coinfected with tuberculosis and HIV / Preditores de mortalidade em pacientes da unidade de terapia intensiva coinfectados por tuberculose e HIV

ABSTRACT Objective: To identify factors predictive of mortality in patients admitted to the ICU with tuberculosis (TB)/HIV coinfection in the Manaus, Amazon Region. Methods: This was a retrospective cohort study of TB/HIV coinfected patients over 18 years of age who were admitted to an ICU in the city of Manaus, Brazil, between January of 2011 and December of 2014. Sociodemographic, clinical, and laboratory variables were assessed. To identify factors predictive of mortality, we employed a Cox proportional hazards model. Results: During the study period, 120 patients with TB/HIV coinfection were admitted to the ICU. The mean age was 37.0 ± 11.7 years. Of the 120 patients evaluated, 94 (78.3%) died and 62 (66.0%) of those deaths having occurred within the first week after admission. Data on invasive mechanical ventilation (IMV) and ARDS were available for 86 and 67 patients, respectively Of those 86, 75 (87.2%) underwent IMV, and, of those 67, 48 (71.6%) presented with ARDS. The factors found to be independently associated with mortality were IMV (p = 0.002), hypoalbuminemia (p = 0.013), and CD4 count < 200 cells/mm3 (p = 0.002). Conclusions: A high early mortality rate was observed among TB/HIV coinfected ICU patients. The factors predictive of mortality in this population were IMV, hypoalbuminemia, and severe immunosuppression.

RESUMO Objetivo: Identificar fatores preditores de mortalidade em pacientes da UTI coinfectados por tuberculose (TB)/HIV em Manaus (AM). Métodos: Estudo retrospectivo de coorte com pacientes coinfectados por TB/HIV, com mais de 18 anos de idade e admitidos na UTI entre janeiro de 2011 e dezembro de 2014. Foram avaliadas variáveis sociodemográficas, clínicas e laboratoriais. Para identificar fatores preditores de mortalidade, foi empregado um modelo de riscos proporcionais de Cox. Resultados: Durante o período estudado, 120 pacientes com coinfecção por TB/HIV foram admitidos na UTI. A média de idade foi de 37,0 ± 11,7 anos. Dos 120 pacientes avaliados, 94 (78,3%) morreram; dos 94 óbitos, 62 (66,0%) ocorreram na primeira semana após a admissão. Havia dados sobre ventilação mecânica invasiva (VMI) e SARA referentes a 86 e 67 pacientes, respectivamente. Dos 86, 75 (87,2%) foram submetidos a VMI, e, dos 67, 48 (71,6%) apresentaram SARA. Os fatores que se relacionaram independentemente com a mortalidade foram VMI (p = 0,002), hipoalbuminemia (p = 0,013) e contagem de CD4 < 200 células/mm3 (p = 0,002). Conclusões: Elevada mortalidade precoce foi observada em pacientes com coinfecção por TB/HIV admitidos na UTI. Os fatores preditores de mortalidade nessa população foram VMI, hipoalbuminemia e imunodepressão grave.

Análisis de letalidad en pacientes con diagnóstico de tuberculosis en un centro de alta complejidad en Cali, Colombia / Lethality analysis in patients with tuberculosis diagnosis in a high complexity hospital in Cali, Colombia

Resumen Introducción: En el 2016 la tuberculosis (TBC) fue considerada la novena causa de muerte en el mundo y la primera por un único agente infeccioso, con aproximadamente 1,6 millones de muertes y una letalidad de 15%. Más de 95% de los casos de mortalidad mundial se presentan en países en vía de desarrollo como Colombia. Objetivo: Describir las características sociodemográficas y clínicas de los pacientes que fallecieron durante el tratamiento antituberculoso en un centro de alta complejidad en Cali, Colombia. Métodos: Estudio analítico de cohorte retrospectiva, realizado entre 2007-2016 en la Fundación Valle del Lili. Se incluyeron pacientes con diagnóstico de TBC con seguimiento clínico, que fallecirron por cualquier causa. Resultados: De 787 pacientes diagnosticados con TBC, murieron 69 (8,8%). La mayoría de los fallecidos (59%) fueron hombres, edad promedio de 51,9 años. Hubo retraso diagnóstico en 51% de los pacientes y 75% presentaron TBC pulmonar. El 64% murió en los primeros 30 días posteriores al diagnóstico de TBC y 61% de las muertes fueron atribuibles a TBC. Co-infección TBC e infección por VIH se presentó en 23% de los casos. La edad avanzada (> 65 años) se asoció a muerte en menos de 30 días desde el diagnóstico de TBC (p < 0,001). Discusión: La letalidad encontrada es superior a lo esperado (8,8%); la mayoría de los pacientes fallecidos presentó co-morbilidades graves. La edad avanzada se asoció a muerte temprana. El principal mecanismo fisiopatológico de muerte por TBC en este estudio fue el choque séptico secundario a neumonía grave tuberculosa.

Background In 2016 tuberculosis (TB) was considered the ninth leading cause of death worldwide and the leading cause of a single infectious agent, with approximately 1.6 million deaths worldwide and a lethality of 15%. Over 95% of cases and deaths are in developing countries like Colombia. Aim: To describe the sociodemographic and clinical characteristics of patients who died during TB treatment in a high complexity hospital in Cali, Colombia. Methods: We conducted an analytic retrospective cohort during 2007-2016 in Fundación Valle del Lili. We included patients with TB diagnosis, who died during TB treatment. Results: From 787 patients with TB, 69 died (8.8%). Fifty nine percent were male, the average of age was 51.9 years. There was diagnosis delay in 51% of the patients and 74% presented pulmonary TB. Sixty four percent 64 died in the first 30 days of the TB diagnosis and 61% of the deaths were attributable to TB. Twenty five percent of patients had TB/HIV coinfection. Elderly patients (> 65 years old) were associated with death in the first 30 days of TB diagnosis (p < 0,001). Discussion: The lethality found in this study was higher than expected (8.8%), the majority of patients had serious comorbidities. Elderly patients were associated with early death. The main pathophysiological mechanism of death was septic shock caused by severe tuberculous pneumonia.

Co-infección por los virus del dengue y chikungunya: revisión narrativa / Coinfection of dengue and chikungunya viruses: narrative review

Resumen Introducción: Los virus del dengue y chikungunya son transmitidos por la hembra de los mosquitos Aedes aegypti y Aedes albopictus, ampliamente distribuidos en zonas tropicales y subtropicales, lo que facilita la co-infección. Objetivo: Determinar la magnitud, la distribución geográfica y el cuadro clínico de la co-infección por dengue y chikungunya. Material y Métodos: Revisión narrativa. Búsqueda en las bases de datos PubMed y Lilacs, utilizando los términos MeSH "Chikungunya", "CHIKV", "DENV", "Dengue" y "coinfection. Se incluyeron los artículos de los últimos 20 años. Resultados: Se incluyeron 45 artículos. El mayor reporte de co-infección fue en Asia seguido de África. En las Américas la información es limitada por la reciente circulación del chikungunya. La magnitud de la co-infección varió entre 0 y 31,9%. No se encontraron diferencias en la distribución de la co-infección por sexo y edad. El cuadro clínico de la mono-infección y la co-infección fue similar. Algunos reportes de caso exponen cuadros graves con afección del sistema nervioso central, manifestaciones hemorrágicas y enfermedad de Still. Conclusión: Las manifestaciones clínicas de la co-infección por dengue y chikungunya son similares a la mono-infección, situación que dificulta el diagnóstico y la medición de su magnitud.

Background: Dengue and chikungunya viruses are transmitted by the female Aedes aegypti and Aedes albopictus, which are widely distributed in tropical and subtropical areas, facilitating coinfection. Aim: To determine the magnitude, geographical distribution and clinical picture of dengue and chikungunya coinfection. Material and Methods: Narrative review. A search in the PubMed and Lilacs databases was made, using the MeSH terms "Chikungunya", "CHIKV", "DENV", "Dengue" and "coinfection. The articles of the last 20 years were included. Results: A total of 45 articles were included. The largest coinfection report was in Asia followed by Africa. In the Americas, the information is limited because of the recent circulation of chikungunya. The magnitude of coinfection varies between 0% and 31.9%. No differences were found in the distribution of coinfection by sex and age. The clinical picture of monoinfection and coinfection was similar. Some case reports show severe cases with central nervous system involvement, hemorrhagic manifestations and Still's disease. Conclusion: The clinical manifestations of coinfection by dengue and chikungunya viruses are similar to those due to monoinfection, which difficult the diagnosis and measurement of its magnitude.

Factores asociados a sobrevida en pacientes con co-infección VIH-TBC en el Servicio de Infectología del Hospital Nacional Arzobispo Loayza, Perú, durante los años 2004-2012 / Factors associated to survival in patients with HIV-TB in the Department of Infectious Diseases of the Arzobispo Loayza National Hospital, Perú, since 2004 to 2012

Resumen Introducción La principal causa de muerte en pacientes infectados con VIH es la tuberculosis (TBC). Pocos estudios latinoamericanos han evaluado la sobrevida de pacientes co-infectados. Objetivo Determinar factores asociados a sobrevida en pacientes con co-infección VIH-TBC atendidos en un hospital peruano. Materiales y Métodos Estudio de cohorte, retrospectivo, en base a registros clínicos de pacientes atendidos en el Servicio de Infectología del Hospital Nacional Arzobispo Loayza durante los años 2004-2012. Se evaluó la sobrevida de 315 pacientes, utilizando las curvas de Kaplan-Meier y el método de Riesgos Proporcionales de Cox. Resultados De 315 pacientes, 82 murieron durante el seguimiento. La mediana de seguimiento para cada participante fue de 730 días. El análisis multivariado mostró que recibir TARGA (HR: 0,31; IC: 0,20-0,50; p < 0,01) y tener mayor peso (HR: 0,96; IC 0,94-0,98; p < 0,01) al momento del diagnóstico de la co-infección fueron factores protectores; mientras que tener una patología distinta a TBC (HR: 1,88; IC: 1,19-2,98; p < 0,01), edad mayor a 34 años (HR: 1,76; IC: 1,12-2,74; p ≤ 0,01), y estar hospitalizado al momento del diagnóstico (HR: 1,69; IC 1,02-2,80; p < 0,04) se asociaron a menor sobrevida. Discusión Recibir TARGA y tener mayor peso al momento del diagnóstico de la coinfección se asociaron a mayor sobrevida.

Background The main cause of death in HIV patients is tuberculosis (TB). However, few Latin American studies have evaluated the prognosis of patients with coinfection. Aim To determine the factors associated with survival in patients with HIV-TB coinfection treated at a Peruvian referral hospital. Methods A retrospective cohort study was performed based on clinical records of patients treated at the Department of Infectious Diseases in the Arzobispo Loayza National Hospital from 2004 to 2012. Survival was assessed using the Kaplan-Meier estimator and Cox Proportional Hazard Model. Results From 315 patients, 82 died during the follow-up. The mean of follow for each patient was 730 days. The multivariate analysis showed that receiving HAART (HR: 0,31; IC: 0,20-0,50; p < 0,01) and having more weight (HR: 0,96; IC 0,94-0,98; p < 0,01) when the coinfection was diagnosed, were protective factors; while having a pathology different from TB (HR: 1,88; IC: 1,19-2,98; p < 0,01), age in years (HR: 1,76; IC: 1,12-2,74; p ≤ 0,01) and being hospitalized when diagnosed with TB (HR: 1,69; IC 1,02-2,80; p < 0,04) were associated with lower survival. Discussion Receiving HAART and having more weight when the coinfection is diagnosed were associated with a higher chance of survival.

Mortality related to tuberculosis-HIV/AIDS co-infection in Brazil, 2000-2011: epidemiological patterns and time trends / Mortalidade relacionada à coinfecção tuberculose e HIV/AIDS no Brasil, 2000-2011: padrões epidemiológicos e tendências temporais / Mortalidad relacionada con la coinfección de tuberculosis y VIH/SIDA en Brasil, 2000-2011: patrones epidemiológicos y tendencias temporales

Abstract: Co-infection of tuberculosis (TB)-HIV/AIDS is a persistent public health problem in Brazil. This study describes epidemiological patterns and time trends of mortality related to TB-HIV/AIDS co-infection. Based on mortality data from 2000-2011 (almost 12.5 million deaths), 19,815 deaths related to co-infection were analyzed. The average age-adjusted mortality rate was 0.97 deaths/100,000 inhabitants. The highest mortality rates were found among males, those in economically productive age groups, black race/color and residents of the South region. There was a significant reduction in the mortality coefficient at the national level (annual average percent change: -1.7%; 95%CI: -2.4; -1.0), with different patterns among regions: increases in the North, Northeast and Central regions, a reduction in the Southeast and a stabilization in the South. The strategic integration of TB-HIV/AIDS control programmes is fundamental to reduce the burden of mortality related to co-infection in Brazil.

Resumo: A coinfecção tuberculose (TB)-HIV/AIDS é um problema de saúde pública persistente no Brasil. Neste estudo, descrevem-se padrões epidemiológicos e tendências temporais da mortalidade relacionada à coinfecção TB-HIV/AIDS. Baseado em dados de mortalidade de 2000-2011 (quase 12,5 milhões de mortes), foram analisados 19.815 óbitos relacionados à coinfecção. O coeficiente médio de mortalidade padronizado por idade foi de 0,97 óbitos/100 mil habitantes. Os maiores coeficientes de mortalidade foram verificados no sexo masculino, grupos etários economicamente produtivos, raça/cor negra e residentes da Região Sul. Houve diminuição significativa dos coeficientes de mortalidade em nível nacional (variação percentual anual média: -1,7%; IC95%: -2,4; -1,0), com diferentes padrões entre regiões: aumento nas regiões Norte, Nordeste e Centro-oeste, redução na Sudeste e estabilização na Sul. A integração estratégica dos programas de controle de TB-HIV/AIDS é fundamental para reduzir a carga de mortalidade relacionada à coinfecção no Brasil.

Resumen: La coinfección tuberculosis (TB)-VIH/SIDA es un problema de salud pública persistente en Brasil. En este estudio, se describen patrones epidemiológicos y tendencias temporales de la mortalidad relacionada con la coinfección TB-VIH/SIDA. Basado en datos de mortalidad de 2000-2011 (casi 12,5 millones de muertes), fueron analizadas 19.815 muertes, todas relacionadas con la coinfección. El coeficiente medio de mortalidad ajustado por edad fue de 0,97 muertes/100.000 habitantes. Los mayores coeficientes se verificaron en el sexo masculino, grupos de edad económicamente productivos, raza negra y residentes de la región Sur. Hubo una disminución significativa del coeficiente de mortalidad a nivel nacional (variación porcentual anual media: -1,7%; IC95%: -2,4; -1,0), con diferentes patrones entre regiones: aumento en las regiones Norte, Nordeste y Centro-oeste, reducción en el Sudeste y estabilización en el Sur. La integración estratégica de los programas de control de TB-VIH/SIDA es fundamental para reducir la carga de mortalidad, relacionada con la coinfección en Brasil.

Treatment outcome of human immunodeficiency virus and tuberculosis co-infected patients in public hospitals of eastern and southern zone of Tigray region, Ethiopia

Background: Tuberculosis is a leading cause of death among people living with human immunodeficiency virus. In sub-Saharan Africa, tuberculosis accounts for more than 78% of all deaths among people with human immunodeficiency virus. Objectives: To assess tuberculosis treatment outcome and the associated factors in adult tuberculosis/human immunodeficiency virus co-infected patients in four public hospitals of eastern and southern zone of Tigray region, Ethiopia. Methodology: Institution based cross-sectional study design was used to examine secondary data from tuberculosis/human immunodeficiency virus co-infected patients attending four public hospitals of eastern and southern zone of Tigray, from January 2009 to August 2011. Systematic random sampling technique was used to select individual patient cards from the respective hospitals. Univariate analysis and multivariate logistic regression modeling was used to assess the impact of each variable in predicting treatment outcome. Results: Out of 342 patients included, 199 (58.2%) patients completed treatment, 43 (12.6%) patients were cured, 88 (25.7%) died, 7 (2%) defaulted, and 5 (1.5%) patients failed treatment. Treatment success rate was around 71%. In the multivariate logistic regression analysis the factors that were strongly associated with unfavorable tuberculosis treatment outcomes were WHO stage IV (AOR = 3.2, CI = 1.58-6.82, p-value = 0.001), age greater than 45 years (AOR = 6.08, CI = 2.28-16.23) and baseline CD4 count less than 200 cells/L (AOR = 6.19, CI = 2.28-16.89, p-value = 0.001). Conclusion: The rate of treatment success in this study was lower than the rate newly recommended by WHO. Therefore, efforts should be undertaken to improve treatment success rates of both diseases. .

Secondary Infections in Swine Flu.

Swine influenza is respiratory disease of pigs caused by type A influenza virus that causes regular outbreak in pigs. Human to human transmission occurs. Some people develop severe respiratory symptoms and need ventilator. Patients can get secondary bacterial infections in form of pneumonia if viral infections persist. Death of swine flu occurs due to secondary bacterial infections leading to bacterial pneumonias. Method : 369 patients having acute respiratory illness suspected to be suffering from swine flu were included. Real time reverse transcriptase polymerase chain reaction (RT-PCR) was performed on sputum samples or tracheal aspirates of 134 patients admitted in Hospital due to pneumonia. 90 of these patients were positive for swine flu by RT-PCR. Result : Among 90 patients 55 patients’ shows bacterial growth and 35 patients did not show any growth. Maximum patients 17 shows Klebseilla pneumoniae,17 show Staphylococcus aureus ,10 show Escherichia coli,8 show Pseudomonas aeruginosa and 3 patients show Streptococccus pneumoniae. Even after treatment, death of 36 patients occurred. Among these 36 patients, 19 had both, bacterial as well as swine flu infection and 17 patients had only swine flu infection. Conclusion : Secondary bacterial infections in swine flu patients were multiresistant to antibiotics were noted. Pneumonia caused by co-infection contributes to a severe rapidly progressive illness.

Survival analysis of acquired immune deficiency syndrome patients with and without hepatitis C virus infection at a reference center for sexually transmitted diseases/acquired immune deficiency syndrome in São Paulo, Brazil

INTRODUCTION: Survival of patients with acquired immune deficiency syndrome has improved with combination antiretroviral therapy; mortality due to liver diseases, however, has also increased in these patients. OBJECTIVES: To estimate the accumulated probability of survival in human immunodeficiency virus-hepatitis C virus coinfected and non-coinfected patients and to investigate factors related to acquired immune deficiency syndrome patients' survival. METHODS: Non-concurrent cohort study using data from surveillance information systems of acquired immune deficiency syndrome patients over 13 years of age. Hepatitis C and B, human immunodeficiency virus exposure category, CD4+ T cell count, age group, schooling, race, sex, and four acquired immune deficiency syndrome diagnosis periods were studied. Kaplan-Meier survival analysis and Cox model with estimates of the hazard ratio and 95% confidence interval were used. RESULTS: Of the total 2864 individuals included, with median age was 35 years, 219 died (7.5%), and 358 (12.5%) were human immunodeficiency virus-hepatitis C virus coinfected. The accumulated probability of survival in human immunodeficiency virus-hepatitis C virus coinfected patients, after acquired immune deficiency syndrome diagnosis, at 120 months, was 0%, 38.9%, 83.8% in 1986-1993, 1994-1996, 1997-2002, respectively, and 92.8% at 96 months in 2003-2010; survival in non-coinfected patients at 120 months was 80%, 90.2%, 94% in 1986-1993, 1994-1996, 1997-2002, respectively, and 94.1% at 96 months in 2003-2010. In the multivariate model the following variables were predictive of death: hepatitis C virus coinfection (hazard ratio=2.7; confidence interval 2.0-3.6); Hepatitis B virus coinfection (hazard ratio=2.4; confidence interval 1.7-3.6); being >50 years old (hazard ratio=2.3; confidence interval 1.3-3.8); having 8-11 years of schooling (hazard ratio=1.6; confidence interval 1.1-2.3), having 4-7 years of schooling ...

Tuberculose, HIV e pobreza: tendência temporal no Brasil, Américas e mundo / Tuberculosis, HIV, and poverty: temporal trends in Brazil, the Americas, and worldwide

OBJETIVO: Analisar a tendência temporal das taxas de prevalência, incidência e mortalidade por tuberculose, associada ou não com HIV, no Brasil, nas Américas e no mundo. MÉTODOS: Foram coletados os dados relacionados à tuberculose, com e sem coinfecção por HIV, entre 1990 e 2010, no Brasil, nas Américas e no mundo. As tendências foram estimadas por regressão linear. RESULTADOS: Foi identificada uma tendência de redução nas taxas de prevalência e mortalidade de tuberculose, que foi maior no Brasil e nas Américas que no mundo. Houve uma tendência crescente na incidência da coinfecção tuberculose/HIV e nas taxas de detecção de casos de tuberculose ativa e latente. Houve uma tendência de redução da incidência de tuberculose no Brasil, mas de aumento dessa no mundo. Houve uma correlação direta das taxas de incidência de tuberculose com as taxas de pobreza e as taxas de incidência de HIV. CONCLUSÕES: Desigualdades sociais e o advento da AIDS são os principais fatores que agravam a atual situação da tuberculose. Nesse contexto, abordagens metodológicas para a avaliação das ações de vigilância da tuberculose são bem-vindas, pois essas indicarão situações de dados de notificação da tuberculose que não reflitam a verdadeira incidência dessa doença.

OBJECTIVE: To analyze the temporal trends of the incidence and prevalence of tuberculosis, with and without HIV co-infection, as well as of the associated mortality, in Brazil, the Americas, and worldwide. METHODS: We collected data related to tuberculosis, with and without HIV co-infection, between 1990 and 2010, in Brazil, the Americas, and worldwide. Temporal trends were estimated by linear regression. RESULTS: We identified a trend toward a decrease in tuberculosis prevalence and mortality, and that trend was more pronounced in Brazil and the Americas than worldwide. There was also a trend toward an increase in the incidence of tuberculosis/HIV co-infection, as well as in the rates of detection of new cases of active and latent tuberculosis. The incidence of tuberculosis was found to trend downward in Brazil, whereas it trended upward worldwide. Tuberculosis incidence rates correlated positively with poverty rates and with HIV incidence rates. CONCLUSIONS: Social inequality and the advent of AIDS are the major factors that aggravate the current situation of tuberculosis. In this context, methodical approaches to the assessment of surveillance activities are welcome, because they will identify situations in which the reported tuberculosis data do not reflect the true incidence of this disease.