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1.
Vaccimonitor (La Habana, Print) ; 30(2)mayo.-ago. 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1252327

ABSTRACT

La gastroenteritis causada por rotavirus constituye un importante problema de salud mundial, por lo que se recomienda incluir la vacunación contra el rotavirus en los programas de inmunización. Para evaluar el impacto de una futura introducción en Cuba de una vacuna contra este patógeno, resulta necesario crear una línea de base pre-vacunación de la carga de la gastroenteritis causada por este virus. Entre noviembre 2017 a abril 2018 se implementó en el Hospital Pediátrico de Centro Habana un sistema de vigilancia para la gastroenteritis causada por rotavirus. Se establecieron las definiciones para las categorías de caso sospechoso, probable y confirmado. Por cada niño captado se recogió una muestra de heces que se analizó con tiras rápidas y se confirmó la presencia de rotavirus por ELISA. Para determinar la severidad de la enfermedad se utilizó la escala de Vesikari. Los resultados fueron expresados en cifras absolutas y relativas, el análisis se realizó a través de la prueba de chi-cuadrado. Del total de ingresos por enfermedad diarreica aguda, el 26 por ciento cumplió los criterios de inclusión y el 46 por ciento resultó confirmado como rotavirus. El hacinamiento en el hogar y asistir al círculo infantil se comportaron como factores de riesgo. El servicio de gastroenterología absorbió la mayor carga de ingresos hospitalarios por esta causa. Los resultados mostrados validan la funcionalidad del sistema de vigilancia implementado y brindan nuevas evidencias sobre la carga de la enfermedad y la utilización de los servicios de un hospital pediátrico cubano, debido a la gastroenteritis provocada por rotavirus, lo que justifica la introducción de la vacuna(AU)


Gastroenteritis caused by rotavirus is a major global health problem, therefore it is recommended that vaccination against rotavirus be included in immunization programs. To evaluate the impact of a future introduction in Cuba of a vaccine against this pathogen, it is necessary to have a pre-vaccination baseline of the burden of gastroenteritis caused by rotavirus. Between November 2017 and April 2018, a surveillance system for gastroenteritis caused by rotavirus was implemented in the Paediatric Hospital of Centro Habana. Definitions were established for the categories of suspected, probable and confirmed cases. For each captured child, stool samples were collected, analyzed with rapid strips and confirmated by ELISA. To determine the severity of the disease, the Vesikari score was used. The results were expressed in absolute and relative figures; the analysis was performed through chi-square. Of the total admissions for acute diarrheal disease, 26 percent met the inclusion criteria and 46 percent were confirmed for rotavirus. Overcrowding at home and attending a day care center were risk factors. The gastroenterology service absorbed the greatest burden of hospital admissions for this cause. The results shown validate the role of the implemented surveillance system and provide new evidence on the burden of disease and use of services for rotavirus gastroenteritis in a cuban pediatric hospital(AU)


Subject(s)
Humans , Male , Female , Child, Preschool , Rotavirus Infections/prevention & control , Risk Factors , Rotavirus Vaccines , Diarrhea/etiology , Gastroenteritis/epidemiology , Epidemiology, Descriptive , Prospective Studies , Cuba , Observational Studies as Topic
2.
J. pediatr. (Rio J.) ; 97(2): 197-203, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1287031

ABSTRACT

Abstract Objective: Irritable bowel syndrome is a frequent functional gastrointestinal disorder. The aims of this study were to investigate its epidemiology, focusing on the role of intestinal mucosal integrity and to evaluate the impact on the quality of life. Methods: A community-based survey applying a comparative cross sectional approach was conducted in six high schools in Palembang. Subjects were recruited using multistage random sampling divided in two groups. Rome III criteria were used to establish a diagnosis of IBS in combination with a questionnaire to determine risk factors. Determination of fecal alpha-1-antitrypsin and calprotectin levels was performed to determine impaired intestinal mucosal integrity. A questionnaire was used to evaluate how quality of life was affected by irritable bowel syndrome. Results: The survey was performed in 454 14−18 years old adolescents, of whom 30.2% fulfilled the Rome III criteria for IBS, with the following subtypes: 36.5% diarrhea, 18.9% constipation, 21.9% mixed, and 22.6% unclassified. Major risk factors were female gender, bullying, age 14-16 years, history of constipation and diarrhea, eating nuts, and drinking coffee, tea, and soft drinks. There was a significant association with intestinal inflammation (p = 0.013). A significantly impaired quality of life was found (p = 0.001). Conclusions: The prevalence of irritable bowel syndrome in adolescents was high, with bullying, female gender, age 14-16 years, constipation and diarrhea, and dietary consumption of soft drinks, coffee, and tea as risk factors. A significant association with intestinal inflammation was found.


Subject(s)
Humans , Male , Female , Adolescent , Irritable Bowel Syndrome/epidemiology , Quality of Life , Cross-Sectional Studies , Surveys and Questionnaires , Constipation/etiology , Constipation/epidemiology , Diarrhea/etiology , Diarrhea/epidemiology , Indonesia/epidemiology
3.
Arq. gastroenterol ; 57(4): 354-360, Oct.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1142334

ABSTRACT

ABSTRACT BACKGROUND: Cancer patients may have gastrointestinal changes that influence nutritional status. OBJECTIVE: To investigate the occurrence of gastrointestinal changes resulting from outpatient chemotherapy treatment in cancer patients. METHODS: In a retrospective longitudinal study, the nutritional status and chemotherapy gastrointestinal changes (nausea, vomit, diarrhea, constipation, mucositis, dysphagia, xerostomia, inappetence, dysgeusia and heartburn) in cancer patients (n=187) were investigated in an outpatient follow-up. For the study of the parameters over time, the generalized estimating equation (GEE) method was used. Kruskal-Wallis, Mann-Whitney tests and Spearman coefficient, at a significance level of 5% were also used. RESULTS: The majority of the patients were female (63.64%) and the mean age was 57.5±12.1 years. The most frequent symptoms were nausea (18.54%); inappetence (18.31%); intestinal constipation (11.58%); diarrhea (7.98%); xerostomia (7.59%) and vomiting (7.43%). The nutritional status did not exhibit any relevant changes (P=0.7594). However, a higher prevalence of eutrophy was observed, followed by overweight; vomiting exhibited a significant difference (P=0.0211). The nausea symptom exhibited a significant difference with a higher prevalence of colorectal neoplasia when compared to breast neoplasia (P=0.0062); as well as vomiting in lung and colorectal neoplasias (P=0.0022), and dysphagia, in head and neck neoplasia, when compared to other neoplasms (P<0.001). There was a statistically significant difference between the number of medical appointments and gender (P=0.0102) and between dysphagia and gender (P<0.0001). CONCLUSION: The study findings enhance the need for signs and symptoms follow up, as well as nutritional status follow up of patients undergoing outpatient chemotherapy.


RESUMO CONTEXTO: Pacientes oncológicos podem apresentar alterações gastrointestinais que influenciam o estado nutricional. OBJETIVO: Investigar a ocorrência de alterações gastrointestinais decorrentes do tratamento ambulatorial de quimioterapia, em pacientes oncológicos. MÉTODOS: Num estudo longitudinal retrospectivo, investigou-se o estado nutricional e as alterações gastrointestinais (náuseas, vômito, diarreia, constipação, mucosite, disfagia, xerostomia, inapetência, disgeusia e pirose) de pacientes oncológicos (n=187), em acompanhamento ambulatorial de quimioterapia. Para o estudo dos parâmetros ao longo do tempo, utilizou-se o método das equações de estimação generalizadas (EEG). Também foram utilizados os testes de Kruskal-Wallis, Mann-Whitney e o coeficiente de Spearman, com nível de significância de 5%. RESULTADOS: A maioria dos pacientes era do sexo feminino (63,64%) e a média de idade foi 57,5±12,1 anos. Os sintomas mais frequentes foram náuseas (18,54%); inapetência (18,31%); constipação intestinal (11,58%); diarreia (7,98%); xerostomia (7,59%) e vômito (7,43%). O estado nutricional não apresentou alterações relevantes (P=0,7594). No entanto, observou-se maior prevalência de eutrofia, seguido do sobrepeso e o vômito apresentou diferença significativa (P=0,0211). O sintoma de náusea apresentou diferença significativa com maior prevalência na neoplasia colorretal, quando comparado à neoplasia de mama (P=0,0062); assim como o vômito nas neoplasias de pulmão e colorretal (P=0,0022). E a disfagia, na neoplasia de cabeça e pescoço, quando comparada às demais neoplasias (P<0,001). Houve diferença estatisticamente significante entre o número de consultas médicas e sexo (P=0,0102) e entre disfagia e sexo (P<0,0001). CONCLUSÃO: Os achados encontrados no estudo permitem reforçar a necessidade do acompanhamento de sinais e sintomas, bem como do estado nutricional, de pacientes em acompanhamento ambulatorial de quimioterapia.


Subject(s)
Humans , Female , Adult , Aged , Outpatients , Gastrointestinal Diseases/etiology , Neoplasms/complications , Neoplasms/drug therapy , Antineoplastic Agents/therapeutic use , Vomiting/etiology , Weight Loss , Nutritional Status , Retrospective Studies , Follow-Up Studies , Longitudinal Studies , Constipation/etiology , Diarrhea/etiology , Dyspepsia/etiology , Middle Aged , Nausea
4.
Rev. Soc. Bras. Med. Trop ; 53: e20200494, 2020. tab
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1136860

ABSTRACT

Abstract Diagnosing cases of coronavirus disease (COVID-19) with only non-respiratory symptoms has been challenging. We reported the diagnosis of a child who tested positive for COVID-19 with abdominal pain/diarrhea and tracked his family cluster. One member of the family tested positive for COVID-19 on real-time reverse-transcription polymerase chain reaction assay and three other family members had anti-SARS-CoV-2 antibodies.


Subject(s)
Humans , Male , Pneumonia, Viral/diagnosis , Coronavirus Infections/diagnosis , Coronavirus/isolation & purification , Diarrhea/diagnosis , Pandemics , Pharyngitis/etiology , Abdominal Pain/etiology , Cluster Analysis , Contact Tracing , Coronavirus Infections , Clinical Laboratory Techniques , Diarrhea/etiology , Fever/etiology , Betacoronavirus
5.
Article in English | LILACS | ID: biblio-1057212

ABSTRACT

ABSTRACT Objective: To report a case of a child with primary immunodeficiency who at eight years developed digestive symptoms, culminating with the diagnosis of a neuroendocrine tumor at ten years of age. Case description: One-year-old boy began to present recurrent pneumonias in different pulmonary lobes. At four years of age, an immunological investigation showed a decrease in IgG and IgA serum levels. After the exclusion of other causes of hypogammaglobinemia, he was diagnosed with a Common Variable Immunodeficiency and started to receive monthly replacement of human immunoglobulin. The patient evolved well, but at 8 years of age began with epigastrium pain and, at 10 years, chronic persistent diarrhea and weight loss. After investigation, a neuroendocrine tumor was diagnosed, which had a rapid progressive evolution to death. Comments: Medical literature has highlighted the presence of gastric tumors in adults with Common Variable Immunodeficiency, emphasizing the importance of early diagnosis and the investigation of digestive neoplasms. Up to now there is no description of neuroendocrine tumor in pediatric patients with Common Variable Immunodeficiency. We believe that the hypothesis of digestive neoplasm is important in children with Common Variable Immunodeficiency and with clinical manifestations similar to the case described here in the attempt to improve the prognosis for pediatric patients.


RESUMO Objetivo: Relatar um caso de criança portadora de imunodeficiência primária que, aos oito anos, desenvolveu sintomas digestivos, culminando com o diagnóstico de tumor neuroendócrino aos dez anos de idade. Descrição do caso: Menino, com um ano de idade, começou a apresentar pneumonias de repetição em diferentes lobos pulmonares. Aos quatro anos, a investigação imunológica mostrou diminuição dos níveis séricos de IgG e IgA. Após exclusão de outras causas de hipogamaglobulinemia, teve diagnóstico de imunodeficiência comum variável, passando a receber reposição mensal de imunoglobulina humana. Evoluiu bem, porém, aos oito anos, começou com epigastralgia e, aos dez anos, diarreia crônica persistente e perda de peso. O quadro culminou com o diagnóstico de tumor neuroendócrino intestinal, de rápida progressão, com óbito do paciente. Comentários: A literatura tem chamado a atenção para tumores gástricos em adultos com imunodeficiência comum variável, alertando para a importância do diagnóstico precoce e da pesquisa de neoplasias digestivas. Até o momento, não há descrição de tumor neuroendócrino em pacientes pediátricos portadores de imunodeficiência comum variável. Acredita-se ser importante a hipótese de neoplasia digestiva diante de crianças com imunodeficiência comum variável e com manifestações clínicas semelhantes ao caso descrito, na tentativa de melhorar o prognóstico para pacientes pediátricos.


Subject(s)
Humans , Male , Child , Pneumonia/diagnosis , Common Variable Immunodeficiency/complications , Neuroendocrine Tumors/diagnosis , Pneumonia/etiology , Recurrence , Weight Loss , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Common Variable Immunodeficiency/immunology , Neuroendocrine Tumors/pathology , Neuroendocrine Tumors/therapy , Fatal Outcome , Diarrhea/diagnosis , Diarrhea/etiology , Intestinal Neoplasms/surgery , Intestinal Neoplasms/pathology , Intestinal Neoplasms/diagnostic imaging , Neoplasm Metastasis/pathology , Antineoplastic Agents/therapeutic use
6.
Clinics ; 75: e2209, 2020. tab
Article in English | LILACS | ID: biblio-1133484

ABSTRACT

OBJECTIVES: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS: This cross-sectional study included 471 samples collected from 371 patients (age<18 years) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study group comprised 66/371 (18%) laboratory-confirmed pediatric COVID-19 patients: 61 (92.5%) patients tested positive on real-time reverse transcription-polymerase chain reaction tests for SARS-CoV-2, and 5 (7.5%) patients tested positive on serological tests. MIS-C was diagnosed according to the criteria of the Center for Disease Control. RESULTS: MIS-C was diagnosed in 6/66 (9%) patients. The frequencies of diarrhea, vomiting, and/or abdominal pain (67% vs. 22%, p=0.034); pediatric SARS (67% vs. 13%, p=0.008); hypoxemia (83% vs. 23%, p=0.006); and arterial hypotension (50% vs. 3%, p=0.004) were significantly higher in patients with MIS-C than in those without MIS-C. The frequencies of C-reactive protein levels >50 mg/L (83% vs. 25%, p=0.008) and D-dimer levels >1000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (p<0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p=0.003), mechanical ventilation (83% vs. 7%, p<0.001), vasoactive agent use (83% vs. 3%, p<0.001), shock (83% vs. 5%, p<0.001), cardiac abnormalities (100% vs. 2%, p<0.001), and death (67% vs. 3%, p<0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p=0.003), intravenous immunoglobulin therapy (67% vs. 2%, p<0.001), aspirin therapy (50% vs. 0%, p<0.001), and current acute renal replacement therapy (50% vs. 2%, p=0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly associated with gastrointestinal manifestations [odds ratio (OR)=10.98; 95%CI (95% confidence interval)=1.20-100.86; p=0.034] and hypoxemia [OR=16.85; 95%CI=1.34-211.80; p=0.029]. Further univariate analysis showed a positive association between MIS-C and death [OR=58.00; 95%CI=6.39-526.79; p<0.0001]. CONCLUSIONS: Pediatric patients with laboratory-confirmed COVID-19 with MIS-C had a severe clinical spectrum with a high mortality rate. Our study emphasizes the importance of investigating MIS-C in pediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxemia.


Subject(s)
Humans , Male , Child , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Coronavirus Infections/complications , Coronavirus Infections/mortality , Coronavirus , Pandemics , Respiration, Artificial , Vomiting/etiology , Abdominal Pain/etiology , Cross-Sectional Studies , Immunoglobulins, Intravenous/therapeutic use , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Systemic Inflammatory Response Syndrome/epidemiology , Diarrhea/etiology , Fever/etiology , Betacoronavirus , SARS-CoV-2 , COVID-19 , Glucocorticoids/therapeutic use , Mucocutaneous Lymph Node Syndrome/therapy , Mucocutaneous Lymph Node Syndrome/epidemiology , Mucocutaneous Lymph Node Syndrome/virology
7.
Pesqui. vet. bras ; 39(8): 630-634, Aug. 2019. tab
Article in English | LILACS, VETINDEX | ID: biblio-1040734

ABSTRACT

This study carried out a survey about enteropathogenic agents in domestic cats' shelter as a stage of investigation for the intermittent chronic diarrhea. Individual fecal samples from 39 cats with free access to the external environment were submitted to parasitological examination, parvovirus, and coronavirus by PCR, and Cryptosporidium spp., Giardia spp. and Tritrichomonas foetus by real-time PCR. From the cats evaluated, 30 (76.9%) were positive for one or more enteric agents, and coinfections were observed in 11 cats samples (28.2%). Helminth eggs were observed in 48.7% of cats (19/30), 16 (41%) were positive for parvovirus or coronavirus and 25.6% (10/30) were infected by protozoa. From the positives for protozoa, five cats were positive to T. foetus (12.82%). The first finding of this protozoan through PCR was in the southern Brazil, and the second was in the whole country. Chronic diarrhea in cats may be multifactorial in shelter animals where the population density is high and the control of parasitic, and viral infections are deficient. Moreover, it is due to poor hygiene conditions in these shelters. The factors associated with the proliferation of infectious diseases in shelters are correlated with new pathogens infections such as T. foetus.(AU)


Uma pesquisa de agentes enteropatogênicos em gatos domésticos de um abrigo foi realizado como etapa da investigação das causas de diarreias crônicas intermitentes. Amostras fecais individuais de 39 gatos, com livre acesso ao ambiente externo, foram obtidas para pesquisa de helmintos através do exame parasitológico, investigação de parvovírus e coronavírus e de Cryptosporidium spp., Giardia spp. e Tritrichomonas foetus através de PCR em tempo real. Dos gatos avaliados, 30 (76,9%) foram positivos para algum ou mais de um destes agentes entéricos. Desses, 11 (28,2%) apresentaram co-infecções parasitárias. Ovos de helmintos foram observados em 48,7% dos gatos (19/30), 16 felinos (41%) foram positivos para parvovírus ou coronavírus e 25,6% (10/30) estavam infectados por protozoários. Dos positivos para protozoários, cinco apresentaram Tritrichomonas foetus (12,82%), um organismo pouco relatado no Brasil, sendo este o primeiro relato de detecção deste protozoário através de PCR em fezes de gatos no Sul do Brasil e o segundo no país. A diarreia crônica em gatos pode ser multifatorial em animais de abrigo onde a densidade populacional é elevada e os meios de controle parasitário e viral são deficitários, além das condições de higiene precárias. Os fatores associados à proliferação de doenças infecciosas em abrigos promovem o surgimento de infecções por novos patógenos como o Tritrichomonas foetus, até então pouco relatado no Brasil.(AU)


Subject(s)
Animals , Cats , Parasitic Diseases, Animal/diagnosis , Tritrichomonas foetus , Diarrhea/etiology , Diarrhea/veterinary , Brazil , Polymerase Chain Reaction/veterinary , Coinfection/veterinary , Housing, Animal
8.
Gastroenterol. latinoam ; 30(supl.1): S26-S30, 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1116309

ABSTRACT

Acute diarrhea (AD) is the increase in frequency and volume of bowel movements with decrease in their consistency that lasts less than 14 days. AD is a major public health problem and is still nowadays a cause of significant morbidity and mortality during childhood, especially in children with nutritional deficits. At a younger age, there is a greater susceptibility to diarrhea, which is more intense and more likely cause dehydration. The prevention and management of dehydration is the mainstay of treatment. The use of medications must be used with caution, analyzing individual cases and based on the best available evidence. We will analyze the subject with special emphasis on treatment according to scientific evidence.


La diarrea aguda (DA) se define como el aumento en la frecuencia y volumen de las deposiciones con disminución de la consistencia y que dura menos de 14 días. La DA es un gran problema de salud pública y es aún hoy en día una causa de importante morbimortalidad durante la infancia en especial en niños con déficits nutricionales. A menor edad hay mayor susceptibilidad de presentar diarrea, siendo ésta de mayor intensidad y con mayores posibilidades de producir deshidratación. La prevención y el manejo de la deshidratación es el pilar fundamental del tratamiento. El uso de medicamentos debe ser criterioso, analizando cada caso individual y basado en la mejor evidencia disponible. Analizaremos el tema con especial énfasis en el tratamiento según evidencia científica.


Subject(s)
Humans , Infant , Child, Preschool , Diarrhea/diagnosis , Diarrhea/drug therapy , Rehydration Solutions/therapeutic use , Acute Disease , Ondansetron/therapeutic use , Probiotics/therapeutic use , Dehydration/etiology , Diarrhea/etiology , Diarrhea/prevention & control , Anti-Bacterial Agents/therapeutic use
9.
Gastroenterol. latinoam ; 30(2): 107-112, 2019. ilus
Article in Spanish | LILACS | ID: biblio-1103913

ABSTRACT

Intestinal parasitic infections cause a not insignificant number of chronic diarrhea in children, however, with the sociodemographic change that our country has experienced, the number of cases and new parasites (immigration from tropical endemic areas) could increase. We report the case of an immunocompetent patient who presents with chronic diarrhea associated with Strongyloides stercoralis infection. The patient migrated two years ago from an endemic area for this helminth. The diagnosis is challenging, and the chances of a successful outcome depend on the administration of the antiparasitic.


Las infecciones parasitarias intestinales provocan un número no despreciable de causas de diarrea crónica en niños, sin embargo, con el cambio sociodemográfico que ha vivido nuestro país se podría incrementar el número de casos y de nuevos parásitos (inmigración de áreas endémicas tropicales). Reportamos el caso de un paciente inmunocompetente, que presenta cuadro de diarrea crónica asociada a infección por Strongyloides stercoralis. El paciente habría migrado hace dos años desde zona endémica para este helminto. El diagnóstico es desafiante y las posibilidades de un resultado exitoso dependen de la administración del antiparasitario.


Subject(s)
Humans , Male , Adult , Strongyloidiasis/diagnosis , Strongyloidiasis/drug therapy , Intestinal Diseases, Parasitic/diagnosis , Intestinal Diseases, Parasitic/drug therapy , Strongyloidiasis/parasitology , Tomography, X-Ray Computed , Albendazole/therapeutic use , Strongyloides stercoralis/isolation & purification , Diarrhea/etiology , Immunocompetence , Intestinal Diseases, Parasitic/parasitology
10.
Gastroenterol. latinoam ; 30(supl.1): S35-S38, 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1116420

ABSTRACT

Microscopic colitis (MC) is a clinical condition characterized by chronic watery diarrhea, normal colonic mucosa and characteristic histological findings. It is composed of two main entities: collagenous colitis (CC) and lymphocytic colitis (LC). Its incidence has been increasing, currently accounting for between 8 to 16% of studies for chronic diarrhea. It is more frequent in elderly women and is strongly associated with other autoimmune disorders. Its pathogenesis is not very well understood, but it supposes the immune activation secondary to the exposure of the colonic mucosa to different luminal antigens, mainly drugs. Management includes suspension of the potential causative agent and the use of anti-diarrheal medications. Oral budesonide has proven to be effective in induction and maintenance of remission, but with a high rate of recurrence upon discontinuation. Immune-modulators drugs such as azatioprine and metrotrexate have been tested in patients dependent to corticoids with variable results. Antibodies against tumor necrosis factors (TNF) are under studies, with promising results.


La colitis microscópica (CM) es una condición clínica caracterizada por diarrea crónica acuosa con mucosa colónica normal y hallazgos histológicos característicos. Está compuesta por dos entidades principales: la colitis colágena (CC) y la colitis linfocítica (CL). Su incidencia ha ido en aumento, siendo en la actualidad la responsable del 8 a 16% de los casos por diarrea crónica. Es más frecuente en mujeres de edad avanzada con una fuerte asociación a otras enfermedades autoinmunes. Su etiopatogenia no es del todo conocida, pero se cree juega un rol la activación inmune secundaria a la exposición de la mucosa colónica a diferentes antígenos luminales, principalmente fármacos. Dentro del manejo se incluye la suspensión del potencial agente causal y el uso de fármacos antidiarreicos. La budesonida oral ha demostrado alta efectividad en la inducción y mantención de la remisión, pero con una alta tasa de recurrencia al suspenderla. Fármacos inmunomoduladores como azatioprina y metrotrexato se han probado en pacientes corticodependendientes con resultados variables. El uso de anticuerpos monoclonales anti factor de necrosis tumoral (TNF) se encuentra en estudio, con resultados prometedores.


Subject(s)
Humans , Colitis, Microscopic/diagnosis , Colitis, Microscopic/drug therapy , Adrenal Cortex Hormones , Mesalamine/therapeutic use , Budesonide/therapeutic use , Colitis, Collagenous/diagnosis , Colitis, Collagenous/drug therapy , Colitis, Lymphocytic/diagnosis , Colitis, Lymphocytic/drug therapy , Diarrhea/etiology , Anti-Inflammatory Agents/therapeutic use , Antibodies, Monoclonal , Antidiarrheals/therapeutic use
11.
J. Health NPEPS ; 3(2): 413-425, Julho-Dezembro. 2018.
Article in Portuguese | LILACS, BDENF | ID: biblio-980863

ABSTRACT

Objetivo: propor e avaliar indicadores de saúde ambiental dos assentados na faixa fronteiriça cacerense. Método: utilizou-se o estudo descritivo, explicativo, quanti-qualitativo e censo, abrangendo todos os responsáveis pelas propriedades (lotes) dos assentamentos Jatobá, Nova Esperança, Rancho da Saudade, Sapicuá, Corixo, Bom Sucesso e Katira. Para coleta de dados foi aplicado um formulário semiestruturado, no período de março a julho de 2016, a 136 agricultores. Na construção dos indicadores utilizou-se a abordagem derivada do modelo Pressão-Estado-Impacto-Resposta. Os indicadores propostos foram: destinação do lixo, qualidade da água e casos de diarreia em crianças. As fontes de captação de água foram submetidas a quatro análises físico-química e microbiológica. Resultados: na destinação do lixo doméstico predominou a categoria queima com 80,9%, seguida das categorias enterra com 8,8% e queima e enterra com 10,3%. Verificou-se que a água não atende as exigências do Ministério da Saúde, devido à presença de Coliformes Totais. O número de crianças nos assentamentos foi 69, destas 88,40% consomem água dos poços coletivos, 52,45% apresentaram episódios de diarreia. Conclusão: os indicadores mostraram-se eficazes, sendo necessárias ações coletivas de orientações referentes aos cuidados com a destinação do lixo e o isolamento no entorno dos poços, e análises periódicas das águas destes assentamentos.(AU)


Objective: to propose and evaluate indicators of environmental health of the settlers in the border area of Caceres. Method: the descriptive, explanatory, quantitative-qualitative and census study was used, covering all those responsible for the properties (lots) of the Jatobá, Nova Esperança, Rancho da Saudade, Sapicuá, Corixo, Bom Sucesso and Katira settlements. For data collection, a semistructured form was applied, from March to July 2016, to 136 farmers. In the construction of the indicators we used the approach derived from the Pressure-State-Impact-Response model. The proposed indicators were: waste disposal, water quality and cases of diarrhea in children. The sources of water abstraction were submitted to four physical-chemical and microbiological analyzes. Results: domestic waste disposal predominated in the category burned with 80.9%, followed by the categories burial with 8.8% and burning and burial with 10.3%. It was verified that the water does not meet the requirements of the Ministry of Health, due to the presence of Total Coliforms. The number of children in the settlements was 69, of whom 88.40% consume water from the collective wells, 52.45% had episodes of diarrhea. Conclusion: the indicators were effective, requiring collective actions of guidelines regarding waste disposal and isolation in the vicinity of the wells, and periodic analysis of the waters of these settlements.(AU)


Objetivo: proponer y evaluar indicadores de salud ambiental de los asentados en la franja fronteriza cacerense. En el presente trabajo se analizaron los resultados obtenidos en el análisis de los resultados obtenidos en el análisis de los resultados obtenidos. Método: para la recolección de datos se aplicó un formulario semiestructurado, en el período de marzo a julio de 2016, a 136 agricultores. En la construcción de los indicadores se utilizó el abordaje derivado del modelo Presión-Estado-Impacto-Respuesta. Los indicadores propuestos fueron: destino de la basura, calidad del agua y casos de diarrea en niños. Las fuentes de captación de agua se sometieron a cuatro análisis físico-químicos y microbiológicos. Resultados: en la destinación de la basura doméstica predominó la categoría quema con 80,9%, seguida de las categorías enterra con 8,8% y quema y enterra con el 10,3%. Se verificó que el agua no atiende las exigencias del Ministerio de Salud, debido a la presencia de Coliformes Totales. El número de niños en los asentamientos fue 69, de estas 88,40% consumen agua de los pozos colectivos, 52,45% presentaron episodios de diarrea. Conclusión: los indicadores se mostraron eficaces, siendo necesarias acciones colectivas de orientaciones referentes a los cuidados con la destinación de la basura y el aislamiento en el entorno de los pozos, y análisis periódicos de las aguas de estos asentamientos.(AU)


Subject(s)
Humans , Border Areas , Water Quality/standards , Solid Waste/adverse effects , Environmental Health/standards , Health Status Indicators , Diarrhea/etiology , Bolivia , Brazil , Epidemiology, Descriptive , Censuses
12.
Rev. bras. ter. intensiva ; 30(3): 358-365, jul.-set. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-977979

ABSTRACT

RESUMO Para atender as necessidades nutricionais de pacientes admitidos às unidades de terapia intensiva, é necessário estabelecer um plano dietético. As complicações associadas com a nutrição enteral administrada por tubo não são incomuns e podem reduzir o fornecimento das necessidades nutricionais a pacientes internados na unidade de terapia intensiva. Encontram-se em andamento pesquisas relativas a osmolaridade, gorduras, intensidade calórica e conteúdo de fibras das fórmulas, e muitos estudos têm focado na tolerabilidade ao conteúdo de fibras ou na redução de sintomas. Conduzimos uma revisão sistemática do uso e segurança das fibras dietéticas em pacientes críticos, que envolveu oito estudos e teve como base diarreia, outros sintomas gastrintestinais (distensão abdominal, volume gástrico residual, vômitos e constipação), microbiota intestinal, tempo de permanência na unidade de terapia intensiva, e óbito. Discutimos os resultados encontrados na literatura científica, assim como as recomendações atuais. Esta abordagem contemporânea demonstrou que o uso de fibras solúveis em todos os pacientes graves hemodinamicamente estáveis é seguro e deve ser considerado benéfico para redução da incidência de diarreia nesta população.


ABSTRACT To meet the nutritional requirements of patients admitted to intensive care units, it is necessary to establish a diet schedule. Complications associated with enteral nutrition by tube feeding are not uncommon and may reduce the delivery of required nutrient to patients in intensive care units. Research on the osmolality, fat content, caloric intensity and fiber content of formulas are under way, and a substantial number of studies have focused on fiber content tolerability or symptom reduction. We conducted a systematic review of dietary fiber use and safety in critically ill patients in 8 studies based on diarrhea, other gastrointestinal symptoms (abdominal distension, gastric residual volume, vomiting and constipation), intestinal microbiota, length of stay in the intensive care unit and death. We discussed the results reported in the scientific literature and current recommendations. This contemporary approach demonstrated that the use of soluble fiber in all hemodynamically stable, critically ill patients is safe and should be considered beneficial for reducing the incidence of diarrhea in this population.


Subject(s)
Humans , Dietary Fiber/administration & dosage , Enteral Nutrition/methods , Intensive Care Units , Dietary Fiber/adverse effects , Critical Illness , Enteral Nutrition/adverse effects , Critical Care/methods , Diarrhea/etiology , Diarrhea/prevention & control , Length of Stay , Nutritional Requirements
13.
Autops. Case Rep ; 8(3): e2018027, July-Sept. 2018. ilus, tab
Article in English | LILACS | ID: biblio-911941

ABSTRACT

Celiac disease (CD)­also known as gluten-sensitive enteropathy­is a chronic, genetically predisposing and autoimmune entity with a wide range of clinical manifestations triggered by gluten ingestion, which affects 1% of the general population. Currently, up to 60% of the diagnosis of CD is in adults due to the atypical course of the disease. The severe acute onset of CD­also called celiac crisis­is very uncommon and is still not well documented in adults. We report the case of a 58-year-old man who presented a 45-day history of subtle-onset diarrhea followed by malabsorption syndrome with progressive weight loss, anasarca, and electrolyte disturbances. The diagnostic work-up included an upper digestive endoscopy, which showed scalloping of the duodenal mucosa with pathological features confirmed on biopsies. Specific antibodies were positive, and a satisfactory clinical response was obtained once a gluten-free diet was started. Celiac crisis is a rare initial presentation of CD characterized by severe diarrhea, dehydration, weight loss, hypoproteinemia, and metabolic and electrolyte disturbances. Although rare, it should be considered in patients with apparently unexplained chronic diarrhea.


Subject(s)
Humans , Male , Middle Aged , Celiac Disease/diagnosis , Diarrhea/etiology , Malabsorption Syndromes/etiology , Celiac Disease/pathology , Diet, Gluten-Free , Gliadin/therapeutic use , Transglutaminases/therapeutic use
14.
Arch. argent. pediatr ; 116(4): 599-602, ago. 2018. ilus, tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-950050

ABSTRACT

La disentería es un problema frecuente en la primera infancia y, normalmente, es causada por fisuras anales, enteritis infecciosa, proctocolitis alérgica, ingestión de sangre materna e invaginación intestinal. En ocasiones muy poco frecuentes, también puede ser provocada por un vólvulo, por coagulopatías, enterocolitis necrosante, pólipos, diverticulitis de Meckel o enfermedades intestinales inflamatorias (EII). La incidencia de EII en los niños está aumentando y afecta, incluso, a los lactantes. Los subtipos más comunes son la enfermedad de Crohn (EC) y la colitis ulcerosa (CU). Si bien el máximo de ocurrencia de EII se produce entre la segunda y la tercera décadas de vida, la EII pediátrica representa entre el 7% y el 20% de todos los casos. Dentro de este grupo etario, las tasas más elevadas se observan en la adolescencia; sin embargo, hay casos de inicio muy temprano de la EII, incluso antes de los seis años de edad. Los síntomas característicos de la EC incluyen dolor abdominal, diarrea y pérdida de peso, mientras que la CU en general se asocia con diarrea hemorrágica. El informe describe el caso de un niño de 20 meses con disentería, al que finalmente se le diagnosticó CU.


Bloody diarrhea is a common problem in early childhood, typically caused by anal fissures, infectious enteritis, allergic proctocolitis, swallowed maternal blood and intussusception. More rarely, it can also be caused by volvulus, coagulopathies, necrotizing enterocolitis, polyps, Meckel diverticulitis and inflammatory bowel disease (IBD). The incidence of IBD is on the rise in children, even affecting infants. The most common subtypes are Crohn's disease (CD) and ulcerative colitis (UC). While IBD occurrence peaks in the second to third decades of life, paediatric IBD accounts for 7-20% of all cases. Within this age group, the highest rates are seen in the teenage years; however, very early onset IBD can be seen before six years of age. The classic symptoms of CD include abdominal pain, diarrhea and weight loss, while UC is typically associated with bloody diarrhea. The report describes the case of a 20-month-old boy with bloody diarrhea who was ultimately diagnosed with UC.


Subject(s)
Humans , Male , Infant , Colitis, Ulcerative/diagnosis , Diarrhea/etiology , Gastrointestinal Hemorrhage/etiology , Colitis, Ulcerative/physiopathology
16.
Pesqui. vet. bras ; 38(2): 309-314, fev. 2018. tab
Article in English | LILACS, VETINDEX | ID: biblio-895579

ABSTRACT

The aim of this study was to investigate the occurrence of Tritrichomonas foetus in cats in the area surrounding the city of Araçatuba municipality, State of São Paulo, Brazil. Fecal samples from 129 cats were collected by rectal flush technique. It was compared two diagnosis methods, direct examination of feces and PCR. The presence of T. foetus DNA was verified using PCR by amplification of 347-bp fragment from the primers TFR3 and TFR4 and amplicons of positive cases were sequenced. Statistical analyses were performed investigating the associations between T. foetus infection with gender, age, breed, presence of diarrhea and/or history of diarrhea, previous treatment, lifestyle, origin, environment, and co-infection. T. foetus was observed in one sample (n=129) by direct microscopic examination of feces while PCR was positive in five samples (3.9%). Giardia species and Cryptosporidium species co-infection was also observed. Statistical analyses showed no significant associations between T. foetus infection and all listed factors, although most positive cats were asymptomatic and lived in multi-cat household. The isolates of T. foetus showed 100% identical sequences with other T. foetus isolates from cats around the world. So, the occurrence of T. foetus was confirmed in cats in Araçatuba city (Brazil). This parasite must be considered as a differential diagnosis in cats with diarrhea and also in asymptomatic carriers as source of infection in multi-cat environments.(AU)


O objetivo deste estudo foi investigar a ocorrência de Tritrichomonas foetus em gatos na região do município de Araçatuba, SP, Brasil. Foram coletadas amostras fecais de 129 gatos através da técnica de lavado retal. Dois métodos diagnósticos foram comparados, o exame direto das fezes e a PCR. A presença de DNA de T. foetus foi verificada por meio da PCR através da amplificação de 347 pares de bases a partir dos iniciadores específicos TFR3 e TFR4. Posteriormente, os resultados amplificados das amostras positivas foram sequenciadas. Também foi feita análise estatística a fim de investigar a correlação entre infecção por T. foetus e sexo, idade, raça, presença e/ou histórico de diarreia, tratamento prévio, coinfecção, estilo de vida, origem e tipo de ambiente. O protozoário pôde ser observado em uma amostra através do exame direto das fezes e à PCR foram detectadas cinco amostras positivas (3.9%). Foram detectadas coinfecções por Giardia spp. e Cryptosporidium spp. Não foram observadas correlações entre infecção por T. foetus e todos os fatores listados anteriormente, embora a maioria dos felinos positivos fossem assintomáticos e vivessem em ambientes multigatos. O resultado do sequenciamento genético dos isolados das amostras positivas mostrou 100% de similaridade com outros isolados de felinos no mundo. Assim, a ocorrência de T. foetus foi confirmada em gatos em Araçatuba, São Paulo, Brasil. Sendo assim, o parasito deve considerado como diagnóstico diferencial em gatos com diarreia assim como em portadores assintomáticos como fontes de infecção em ambientes multigatos.(AU)


Subject(s)
Animals , Cats , Protozoan Infections/diagnosis , Tritrichomonas foetus/isolation & purification , Parasitic Diseases/diagnosis , Brazil , Polymerase Chain Reaction/veterinary , Diarrhea/etiology
17.
Article in English | AIM, AIM | ID: biblio-1268541

ABSTRACT

Introduction: bacterial agents are among pathogens implicated to cause diarrhea in children resulting to huge mortality and morbidities. Bacterial etiologies causing diarrhea in children below five years are rarely investigated in Central Kenya, which would otherwise guide prescription and target health education.Methods: a cross-sectional study approach was applied on 163 randomly selected stool samples from children below five years who presented with diarrhea in Murang`a and Muriranja`s hospitals. The objective was to determine the bacterial agents of diarrhea. Enteric bacterial pathogens were cultured using appropriate media and identified. Statistical analyses were performed using STATA v.13. Chi-square or Fisher exact-test were used to check for evidence of relationship whenever applicable.Results: there were nearly equal distributions in gender 86 (52.8%) female vs. 77 (47.2%) male, majority (35.6%) aged between 0-12 months. Bacterial isolates were highly diverse in female than the male, children aged 49-60 months and least among those aged 0-12 months. A total of 188 bacterial isolates belonging to 11 genera were recovered. The predominant bacteria was nonpathogenic Escherichia coli 85 (45.2%), while 13 (6.9%) Escherichia coli were positive for virulence genes, including 8 (4.3%) positive for LT and STp Shiga-like or Enterotoxigenic Escherichia coli, 3 (1.6%) positive for eae and bfpA Enteropathogenic Escherichia coli and 2 (1.1%) positive for Enteroaggregative Escherichia coli gene. Others included: Salmonella 21 (11.2%), Pseudomonas 14 (7.4%), Shigella 14 (7.4%), Klebsiella 12 (6.4%), Aeromonas 8 (4.3%), Enterobacter 7 (3.7%), Proteus 8 (4.3%), Citrobactor 3 (1.6%), Yersinia 2 (1.1%) and Vibrio 1 (0.5%).Conclusion: salmonella was the major bacterial isolate and majority of the bacteria were statistically significant cause of diarrhea (p=0.001)


Subject(s)
Child, Preschool , Cross-Sectional Studies , Diarrhea/etiology , Diarrhea/microbiology , Diarrhea/parasitology , Enterobacteriaceae , Kenya , Virulence
18.
Medwave ; 18(4): e7233, 2018.
Article in English, Spanish | LILACS | ID: biblio-912329

ABSTRACT

INTRODUCCIÓN Una de las principales complicaciones de la fractura de órbita son las infecciones, ya sea por la comunicación con los senos paranasales o como complicación postoperatoria de su tratamiento. Pese a los avances en esta patología, aún existe controversia sobre el rol de los antibióticos profilácticos. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos sólo una revisión sistemática que incluyó cuatro estudios primarios, de los cuales tan solo uno corresponde a un ensayo aleatorizado. Concluimos que la profilaxis antibiótica postoperatoria podría no disminuir el riesgo de infección en fractura de órbita, y probablemente aumenta el riesgo de diarrea.


INTRODUCTION Infection is one of the main complications of orbital fracture, either because of the connection to the paranasal sinuses or as a postoperative complication. Despite the advances made in this condition, there is still controversy regarding the role of prophylactic antibiotics. METHODS To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified only one systematic review including four studies overall, of which only one was a randomized trial. We concluded that postoperative antibiotic prophylaxis might not decrease the risk of infection in orbital fracture, and probably increases the risk of diarrhea.


Subject(s)
Humans , Orbital Fractures/surgery , Surgical Wound Infection/prevention & control , Anti-Bacterial Agents/therapeutic use , Randomized Controlled Trials as Topic , Databases, Factual , Treatment Outcome , Diarrhea/etiology , Diarrhea/epidemiology , Anti-Bacterial Agents/adverse effects
19.
Rev. chil. cir ; 69(5): 376-381, oct. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-899620

ABSTRACT

Resumen Introducción: La colecistectomía laparoscópica es una de las intervenciones quirúrgicas más frecuentes en nuestro país. La diarrea poscolecistectomía es una entidad poco reconocida, con una prevalencia descrita entre el 0,9 y 35,6%, sin embargo, en Chile esto no ha sido claramente definido. Objetivo: Determinar la prevalencia y características de la diarrea poscolecistectomía laparoscópica electiva en una muestra de pacientes chilenos. Material y métodos: Se aplicó una encuesta telefónica estructurada sobre consistencia y frecuencia de deposiciones, entre 4 y 6 meses después de la intervención, a los pacientes adultos operados de colecistectomía laparoscópica electivamente entre diciembre de 2014 y marzo de 2015. Se definió como «diarrea poscolecistectomía¼ la presencia de deposiciones líquidas o inusualmente disgregadas que hubiesen comenzado posteriormente a la intervención y se estableció el término de «diarrea prolongada¼ como la duración de síntomas mayor de 4 semanas. Resultados: Se encuestó a 100 pacientes (73% de mujeres). La prevalencia global de diarrea poscolecistectomía fue del 35% (n = 35). La prevalencia de pacientes con diarrea prolongada fue del 15% (n = 15). En el grupo con diarrea prolongada, se observó resolución completa de esta en el 57% de los pacientes (n = 8) en un plazo medio de 99 ± 29 días. Conclusión: La diarrea poscolecistectomía es una entidad frecuente en nuestra población, con una alta prevalencia dentro de los primeros 28 días posteriores a la intervención. En la mayoría de los pacientes se resuelve en los primeros 6 meses.


Abstract Introduction: Laparoscopic cholecystectomy (LC) is one of the most common surgical procedures in our country. Postcholecystectomy diarrhea is an unrecognized entity, with a reported prevalence between 0.9 and 35.6%, nonetheless in Chile this has not been clearly defined. Objective: To determine the prevalence and characteristics of diarrhea following elective laparoscopic cholecystectomy in our institution. Material and methods: A structured questionnaire about consistency and defecation frequency was applied to adult patients summited to an elective LC between December 2014 and February 2015, by a telephone survey within 4 and 6 months after the surgical procedure. Postcholecystectomy diarrhea was defined as the presence of liquid or unusually disrupted faecal material beginning after LC. Persistent diarrhea was established when diarrhea continued for a period longer than four weeks. Results: One hundred patients were included (73% women). The overall prevalence of postcholecystectomy diarrhea was 35% (n = 35). The prevalence of patients with persistent diarrhea was 15% (n = 15). In the group of patients with persistent diarrhea, complete resolution was observed on 57% of the cases (n = 8) within an average period of 99 ± 29 days. Conclusion: Post cholecystectomy diarrhea is a frequent condition in our population, with a high prevalence within the first 28 days after LC. In most patients it resolved within 6 months.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Cholecystectomy, Laparoscopic/adverse effects , Diarrhea/epidemiology , Time Factors , Chile , Prevalence , Surveys and Questionnaires , Risk Factors , Postcholecystectomy Syndrome , Diarrhea/etiology
20.
Rev. Soc. Bras. Med. Trop ; 50(5): 613-620, Sept.-Oct. 2017. tab
Article in English | LILACS | ID: biblio-897008

ABSTRACT

Abstract INTRODUCTION: Visceral leishmaniasis (VL) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) co-infection has been a research topic of interest worldwide. In Brazil, it has been observed that there is a relative underreporting and failure in the understanding and management of this important association. The aim of this study was to analyze epidemiological and clinical aspects of patients with VL with and without HIV/AIDS. METHODS: We conducted an observational and analytical study of patients with VL followed in a Reference Service in the State of Maranhão, Brazil from 2007-2013. RESULTS: In total 126 patients were enrolled, of which 61 (48.4%) were co-infected with HIV/AIDS. There were more males among those with HIV/AIDS (85.2%, P>0.05) or with VL only (81.5%, P>0.05). These findings significantly differed based on age group (P<0.003); the majority of patients were aged 31-40 years (41.0%) and 21-30 years (32.3%) among those with and without HIV/AIDS co-infection, respectively. The incidence of diarrhea and splenomegaly significantly differed between the two groups (P=0.0014 and P=0.019, respectively). The myelogram parasitic examination was used most frequently among those with HIV/AIDS (91.8%), followed by those with VL only (69.2%). VL recurrences and mortality were significantly higher in the HIV/AIDS co-infected patients (P<0.0001 and P=0.012, respectively). CONCLUSIONS: Patients with VL with or without HIV/AIDS co-infection were mostly adult men. Diarrhea was more frequent in HIV/AIDS co-infected patients, whereas splenomegaly was more common in patients with VL only. In the group of HIV/AIDS co-infected patients, there was a higher rate of VL recurrence and mortality.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Aged , Young Adult , Acquired Immunodeficiency Syndrome/epidemiology , Coinfection/epidemiology , Leishmaniasis, Visceral/epidemiology , Socioeconomic Factors , Splenomegaly/etiology , Splenomegaly/epidemiology , Blood Cell Count , Brazil/epidemiology , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/physiopathology , Sex Distribution , Age Distribution , Viral Load , Diarrhea/etiology , Diarrhea/epidemiology , Coinfection/physiopathology , Leishmaniasis, Visceral/complications , Leishmaniasis, Visceral/physiopathology , Middle Aged
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