Hemorrhagic stroke following viper bites and delayed antivenom administration: three case reports from the Western Brazilian Amazon

Abstract Snakebites were included by the World Health Organization in their list of neglected diseases. In Latin America, most snakebites are caused by species of the Viperidae family, notably by the genus Bothrops. Bothrops atrox accounts for 90% of the cases of envenoming in the Brazilian Amazon. In this report, we present a series of three cases of snakebites that evolved with hemorrhagic stroke due to delays in the access to antivenom in the Brazilian Amazon, being fundamental for diagnosis to validate the clinical suspicion and make decisions that would improve the treatment and prognosis of the patients.

Acquired hepatocerebral degeneration in a patient with hepatitis B and hepatitis delta virus coinfection

Abstract Acquired hepatocerebral degeneration is a neurological syndrome with typical clinical (extrapyramidal and neuropsychiatric) symptoms and brain magnetic resonance imaging findings (high T1 signal in the globus pallidus). It occurs mainly in patients with advanced liver disease, such as in patients co-infected with hepatitis B virus (HBV) and hepatitis delta virus (HDV). However, there are no reports relating HBV/HDV coinfection and acquired hepatocerebral degeneration. This report presents the case of a 49-year-old woman with characteristics of acquired hepatocerebral degeneration and liver cirrhosis due to HBV/HDV coinfection, and presents the main theories of the physiopathology of this condition.

Piomiosite tropical por mycobacterium tuberculosis / Tropical pyomiositis caused by mycobacterium tuberculosis

Objetivo: apresentar três casos de piomiosite por Micobacteriumtuberculosis. Relato de casos: três pacientes dosexo feminino com diagnóstico de HIV/AIDS admitidas no Hospital da Fundação de Medicina Tropical HeitorVieira Dourado/AM, acometidas por doenças oportunistas, todas com CD4 abaixo de 200 cel/mm3 e em terapiaantirretroviral. Em um dos casos foi diagnosticado tuberculosepulmonar concomitante à piomiosite, e em outro haviasinais de tuberculose disseminada. Estes tiveram como desfecho, o óbito. Considerações Finais:piomiositetropical écausada por microorganismos que invadem o músculo esquelético por contiguidade ou disseminação hematogênica defoco a distância. Há relato de acometimento em casos de Diabetes mellitus, hepatopatia alcoólica, artrite reumatóide,LES, desnutrição, desordens hematológicas, neutropenia, imunossupressores e infecção por HIV.1,2. Apiomiositeprimária por tuberculose é rara, e se não tratada, a infecção progride com abscessos a distância e complicações comopneumonia, osteomielite, abscesso pulmonar, choque/sepse.

Objective: Present three cases of pyomyositis by Mycobacterium tuberculosis. Case reports: Three female patientsdiagnosed with HIV / AIDS admitted to the Hospital of Tropical Medicine Foundation Heitor Vieira Dourado / AM,affected by opportunistic diseases, all with CD4 counts below 200 cells / mm3 and antiretroviral therapy. In one caseit was diagnosed pulmonary tuberculosis concurrent with pyomyositis, and another had disseminated tuberculosissigns. These had as outcome, death. Final Thoughts:Tropicalpyomyositis is caused by microorganisms that invadethe skeletal muscle by contiguity or hematogenous spread from a distant focus. There report involvement in casesof diabetes mellitus, alcoholic liver disease, rheumatoid arthritis, SLE, malnutrition, blood disorders, neutropenia,immunosuppressive drugs, and HIV infection. 1.2. The primary Pyomyositis tuberculosis is rare, and if left untreated,the infection progresses with distant abscesses and complications such as pneumonia, osteomyelitis, lung abscess,shock / sepsis.

Freqüência de anticorpo anti-Toxocara canis em comunidade do Rio Uatumã, no Estado do Amazonas / Frequency of the antibody anti-Toxocara canis in a community along the Uatumã river, State of Amazonas

Um estudo seccional foi realizado nas Vilas Waimiri e Atroari em Balbina, entre julho e outubro de 2006, com o objetivo de estimar a freqüência de anticorpo antiToxocara canis da classe IgG e avaliar as variáveis epidemiológicas e socioculturais. Foram estudadas 34 famílias e incluídos 100 indivíduos, o que correspondeu a 5 por cento (100/2.000) da população das vilas. A idade variou de zero a 76 anos (M=22,9 Dp=18). Quanto ao gênero, 53 por cento eram femininos e 47 por cento masculino; 52 por cento das amostras foram positivas para Toxocara canis, 44,5 por cento negativas e 3,2 por cento inconclusivas. Observou-se menor número de indivíduos com sorologia negativa na Vila Atroari 29,5 por cento (13/44) em comparação com a Waimiri 46,4 por cento (26/56). Com relação ao contato com cães, dos 55 indivíduos com contato domiciliar 60 por cento (33/55) foram positivos para anticorpo antiToxocara canis Apresentaram sorologia positiva 66,6 por cento (10/15) dos indivíduos que tinham contato domiciliar com filhotes de cão (chi²22,149 p=0,008). A existência de contato domiciliar com cães e filhotes mostrou associação com a presença de anticorpo anti-Toxocara canis na população estudada.

A cross-sectional study was carried out in the Waimiri and Atroari settlements in Balbina, between July and October 2006, with the aims of estimating the frequency of the antibody anti-Toxocara canis of the IgG class and studying the epidemiological and sociocultural variables. Thirty-four families were studied and 100 individuals were included, corresponding to 5 percent (100/2000) of the population of the settlements. The age range was 0-76 years (mean = 22.9; standard deviation = 18). The gender distribution was 53 percent female and 47 percent male. The samples were 52 percent positive for Toxocara canis, 44.5 percent negative and 3.2 percent inconclusive. The number of individuals who tested serologically negative in Atroari (29.5 percent; 13/44) was lower than in Waimiri (46.4 percent; 26/56). In relation to contact with dogs, among the 55 individuals with contact in their homes, 60 percent (33/55) were positive for Ac anti-Toxocara canis and 40 percent (22/55) were negative (chi2= 14.317; p = 0.026). Among the individuals who had contact in their homes with puppies, 66.6 percent (10/15) were serologically positive (chi2= 22.149; p=0.008). The existence of home contact with dogs and puppies showed an association with the presence of Ac anti-Toxocara canis in the study population.