Meningitis posquirúrgica por Acinetobacter baumannii multirresistente. Actividad sinérgica in vivo de la asociación sulbactam/avibactam / Post-surgical meningitis due to multiresistant Acinetobacter baumannii. In vivo synergistic activity of the sulbactam/avibactam association

Acinetobacter baumannii (AB) es un bacilo gram negativo, no fermentador,con frecuencia oportunista, ubicuo en el medio ambiente, con capacidad para sobrevivir en condiciones medioambientales adversas promoviendo su persistencia y diseminación en diferentes áreas de un hospital. Ha sido relacionado con múltiples brotes de infecciones asociadas al cuidado de la salud como neumonía, bacteriemias, contaminación de heridas quirúrgicas o infecciones del tracto urinario, especialmente entre pacientes con comorbilidades graves, como aquellos que motivan el ingreso a unidades de cuidados intensivos (UCI). Las cepas más problemáticas son aquellas resistentes a los carbapenémicos, resistencia causada por enzimas de la clase de las oxacilinasas (bla OXA) cromosómicas o plasmídicas y más recientemente bla NDM-1. La aparición de estas cepas deja escasos antimicrobianos activos (colistin, minociclina, tigeciclina; amikacina) que son limitados en su eficacia y su uso se asocia con toxicidad. A esto se agrega, como en la paciente que se describe, que desarrolló una meningitis posquirúrgica, la limitada capacidad de difusión en el sistema nervioso central (SNC) de estas últimas opciones. Una de las alternativas terapéuticas, es buscar asociaciones como sulbactam/avibactam que mostraron una adecuada actividad sinérgica y bactericida en asilamientos resistentes a ampicilina/sulbactam en base a una significativa reducción de la CIM que permite administrar dosis habituales, con mejor tolerancia y lograr concentraciones terapéuticas en SNC. Se presenta una paciente que desarrolló una meningitis posquirúrgica debida a una cepa de AB multirresistente.

Acinetobacter baumannii (AB) is a non-fermenting gram-negative bacillus, largely opportunistic, ubiquitous in the environment, with the ability to survive in adverse environmental conditions, promoting its persistence and dissemination in different areas of the hospital. It has been implicated in many outbreaks of healthcare-associated infections such as pneumonia, bacteremia, surgical wounds contamination, or urinary tract infections, especially among patients with previous severe illnesses such as those requiring admission to intensive care units (ICU). The most problematic strains are those resistant to carbapenems, resistance caused by chromosomal or plasmid oxacillinase class (bla OXA), and more recently bla NDM-1. The appearance of these strains leaves few active antimicrobials (Colistin, Minocycline, Tigecycline; Amikacin) that are limited in their efficacy and toxic. To this we must add, as is the case of our patient who presented post-surgical meningitis, the limited diffusion capacity in the central nervous system (CNS) of these last options. One of the therapeutic alternatives is to search for synergistic associations such as sulbactam/avibactam that showed rapid synergistic and bactericidal activity in isolates resistant to ampicillin/sulbactam due to a significant reduction in its MIC, which allows us to administer usual, better tolerated doses that reach therapeutic concentrations in CNS. Here, we present a patient who developed a post-surgical meningitis due to multiresistant AB

Meningitis por Aeromonas complejo hydrophila productora de carbapenemasa: a propósito de un caso / Meningitis due to carbapenemase-producing Aeromonas hydrophila: a case report

Se describe una presentación clínica inusual de infección por Aeromonas complejo hydrophila y se destaca la importancia del correcto diagnóstico microbiológico para adecuar el tratamiento. Paciente de 6 años consultó por fiebre y drenaje de líquido serohemático de herida quirúrgica por antecedente de craneotomía con duroplastia la semana previa. Laboratorio con parámetros normales y tomografía computada sin cambios relevantes. Punción lumbar: leucocitos 91/mm3, proteínas 89 mg/dl, glucosa 36 mg/dl. Comenzó tratamiento con vancomicina y ceftazidima. Cultivo de líquido cefalorraquídeo: bacilo gramnegativo, oxidasa positivo, fermentador de glucosa. Se rotó a meropenem. A las 72 horas, se informó, por método difusión y Vitek2, Aeromonas complejo hydrophila: sensible a trimetoprimasulfametoxazol, ciprofloxacina, cefotaxima y meropenem. Se realizó método Blue Carba para detección de carbapenemasas con resultado positivo. Se rotó a trimetoprima-sulfametoxazol. Completó 21 días de tratamiento con evolución clínica favorable

Here we describe an unusual clinical presentation of infection due to Aeromonas hydrophila and underline the importance of a correct microbiological diagnosis for an adequate treatment. A 6-year-old patient with a history of craniotomy with duraplasty the week before consulted for fever and drainage of serosanguineous fluid from the surgical wound. The laboratory parameters were normal and the computed tomography scan showed no relevant changes. Lumbar puncture: leukocytes: 91/mm3; proteins: 89 mg/dL; glucose: 36 mg/dL. Treatment with vancomycin and ceftazidime was started. Cerebrospinal fluid culture: oxidase-positive, glucose-fermenting Gram-negative bacillus. Treatment was changed to meropenem. At 72 hours, using a diffusion method and Vitek 2, it was reported as Aeromonas hydrophila sensitive to trimethoprim-sulfamethoxazole, ciprofloxacin, cefotaxime, and meropenem. The Blue-Carba method was performed to detect carbapenemases; the result was positive. Treatment was changed to trimethoprimsulfamethoxazole. The patient completed 21 days of treatment with a favorable clinical course.

Vigilância epidemiológica hospitalar de Goiás: 1ª coletânea de boletins dos núcleos hospitalares de epidemiologia / Hospital epidemiological surveillance in Goiás: 1st collection of bulletins from hospital epidemiology centers

Coletânea de 13 boletins publicados no site da Secretaria de Estado da Saúde de Goiás, que se destacaram por descrever o perfil de morbimortalidade da unidade e apresentar temas relevantes para a população do Estado de Goiás. Trata-se de um estudo descritivo, realizado com dados do período de janeiro a março de 2023, com informações provenientes das declarações de óbitos e prontuário eletrônico do paciente

Collection of 13 bulletins published on the Goiás State Department of Health website, which stood out for describing the unit's morbidity and mortality profile and presenting relevant themes for the population of the State of Goiás. This is a descriptive study, carried out with data from January to March 2023, with information from death certificates and the patient's electronic medical record

Chronic medical conditions associated with invasive pneumococcal diseases in inpatients in teaching hospitals in São Paulo city: Estimating antimicrobial susceptibility and serotype-coverage of pneumococcal vaccines

Background: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. Methods: A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others RESULTS: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. Conclusion: Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly. Keywords: Antimicrobial resistance; Chronic diseases; Comorbidity; Invasive pneumococcal diseases; Pneumococcal conjugate vaccine; Pneumococcal serotypes; Pneumococcal vaccine.

A multicenter prospective cohort study of late-onset sepsis and its poor prognosis in very low birth weight infants / 中华儿科杂志

Objective: To investigate the prevalence and poor prognosis of late-onset sepsis (LOS) in very low birth weight infant (VLBWI). Methods: This prospective, multicenter observational cohort study was conducted based on the data from Sina-Northern Neonatal Network (SNN). The general data, perinatal information and poor prognosis of 6 639 VLBWI, who were admitted to the 35 neonatal intensive care units from 2018 to 2021, were collected and analyzed. According to the occurrence of LOS during hospitalization, the VLBWI were assigned to the LOS group and non-LOS group. The LOS group was further divided into 3 subgroups according to the occurrence of neonatal necrotizing enterocolitis (NEC) and purulent meningitis. The Chi-square test or Fisher exact probability method, independent sample t test, Mann-Whitney U test and multivariate Logistic regression model were used to analyze the relationship between LOS and poor prognosis in VLBWI. Results: A total of 6 639 eligible VLBWI were enrolled, including 3 402 cases (51.2%) of males and 1 511 cases (22.8%) with LOS. The incidences of LOS in extremely low birth weight infants (ELBWI) and extremely preterm infants were 33.3% (392/1 176) and 34.2% (378/1 105), respectively. There were 157 cases (10.4%) who died in the LOS group and 48 cases (24.9%) in the subgroup of LOS complicated with NEC. Multivariate Logistic regression analysis showed that LOS complicated with NEC was associated with increased mortality and incidence of grade Ⅲ-Ⅳ intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL), moderate or severe bronchopulmonary dysplasia (BPD), and extrauterin growth retardation (EUGR) (ORadjust=5.27, 2.59, 3.04, 2.04; 95%CI 3.60-7.73, 1.49-4.50, 2.11-4.37, 1.50-2.79; all P<0.01); LOS complicated with purulent meningitis was also associated with increased mortality and incidence of grade Ⅲ-Ⅳ IVH or PVL, and moderate or severe BPD (ORadjust=2.22, 8.13, 3.69, 95%CI 1.30-3.37, 5.22-12.67, 2.49-5.48; all P<0.01); the infants without NEC or purulent meningitis in the LOS group was only associated with increased incidence of moderate or severe BPD (ORadjust=2.20, 95%CI 1.83-2.65, P<0.001). After ruling out contaminated bacteria, a total of 456 cases showed positive blood culture, including 265 cases (58.1%) of Gram-negative bacteria, 126 cases (27.6%) of Gram-positive bacteria, and 65 cases (14.3%) of fungi. The most common pathogenic bacteria was Klebsiella pneumoniae (n=147, 32.2%), followed by coagulase-negative Staphylococcus (n=72, 15.8%) and subsequently Escherichia coli (n=39, 8.6%). Conclusions: The incidence of LOS is high in VLBWI. Klebsiella pneumoniae is the most common pathogenic bacteria, followed by coagulase-negative Staphylococcus and Escherichia coli. LOS is associated with a poor prognosis for moderate to severe BPD. The prognosis of LOS complicated with NEC is poor with the highest mortality, and the risk of brain damage is significantly increased when LOS complicated with purulent meningitis.

Impacto da meningite entre os anos de 2010 e 2020 no Brasil: um estudo documental / Impact of meningitis between the years 2010 and 2020 in Brazil: a documentary study

Introdução: a meningite é uma infecção que afeta as membranas as quais revestem o encéfalo e a medula espinhal, sendo incluída na Lista Nacional de Doenças de Notificação Compulsória. Objetivo: investigar o perfil epidemiológico de acometidos por meningite no Brasil, entre os anos de 2010 a 2020. Metodologia: trata-se de um estudo epidemiológico, retrospectivo, analítico e documental, pelo qual as informações acerca dos casos confirmados no Brasil foram extraídas através do Departamento de Informática do Sistema Único de Saúde (DATASUS). Para análise estatística foi utilizado o software Statistical Package for Social Sciences (versão 20.0). Resultados: no período analisado, foram notificados 187.508 casos de meningite, sendo 2012 o ano com maior número de casos (11,6%). A região que apresentou o maior número de mortes foi sudeste (54,2%), possuindo São Paulo como o estado de maior número de notificações (41%). O perfil foi composto, predominantemente, por indivíduos do gênero masculino (59,1%), com faixa etária entre ≤1 a 9 anos (47%) e etiologia viral (45,5%). O método quimiocitológico foi o mais utilizado (60,9%), o qual os enfermos evoluíam a alta (75,8%). Além disso, a meningite bacteriana apresentou a maior taxa de mortalidade (1,8/100.000 habitantes), enquanto a meningococcemia a maior taxa de letalidade (36,7%). Houve associação estatística positiva entre as variáveis: número de óbitos e faixa etária, número de óbitos e gênero e, número de óbitos e etiologia. Conclusão: é essencial a adoção de políticas públicas com escopo às populações de risco, sendo esse estudo, profícuo na construção de tais projetos.

Introduction: meningitis is an infection that affects the membranes that line the brain and spinal cord, being included in the National List of Compulsory Reporting Diseases. Objective: to investigate the epidemiological profile of people affected by meningitis in Brazil, between the years 2010 to 2020. Methodology: this is an epidemiological, retrospective, analytical and documentary study, through which information about confirmed cases in Brazil were extracted through the Department of Informatics of the Unified Health System (DATASUS). For statistical analysis, the Statistical Package for Social Sciences software (version 20.0) was used. Results: in the period analyzed, 187,508 cases of meningitis were reported, with 2012 being the year with the highest number of cases (11.6%). The region with the highest number of deaths was the Southeast (54.2%), with São Paulo as the state with the highest number of notifications (41%). The profile was predominantly composed of male individuals (59.1%), aged between ≤1 to 9 years (47%) and viral etiology (45.5%). The chemocytological method was the most used (60.9%), in which patients progressed to discharge (75.8%). In addition, bacterial meningitis had the highest mortality rate (1.8/100,000 population), while meningococcemia had the highest fatality rate (36.7%). There was a positive statistical association between the variables: number of deaths and age group, number of deaths and gender and number of deaths and etiology. Conclusion: it is essential to adopt public policies aimed at populations at risk, and this study is useful in the construction of such projects.

Identification of spatial patterns in the distribution of meningitis in the State of Mato Grosso ­ Brazil, from 2007 to 2019 / Identificação de padrões espaciais na distribuição da meningite no estado de Mato Grosso ­ Brasil, no período de 2007 a 2019

Objective: to analyze the underreporting of meningitis records in the state of Mato Grosso, under conditions of vulnerability, based on spatial analysis. Methodology: Meningitis cases and estimated population were collected from DataSUS, organized by municipality of residence in the state of Mato Grosso and year of notification. Incidence rates were calculated by dividing the number of cases by the population, multiplying the result by 100,000. For spatial autocorrelation analysis, mean rates were used for the entire period, in addition to the variables percentage of poor, percentage of the population living in households with toilets and running water, and Municipal Human Development Index ­ Income (MHDI Income), obtained from the Atlas of Human Development in Brazil. Results: in general, inverse autocorrelation was observed for the percentage variable of the population living in households with toilets and running water, with municipalities in the center and southeast of the state under high-high autocorrelation and municipalities in the northwest and northeast under low -low. As for the MHDI Income, cities in the center presented high-high autocorrelation and cities in the south and northwest, low-low. Conclusion: the scenario suggests that there is underreporting of meningitis cases in Mato Grosso, as situations marked by less privileged socioeconomic conditions are risk factors for disease transmission. Improvement of health services is suggested, seeking equitable public policies that aim to reduce the existing inequalities in this country.

Objetivo: analisar a subnotificação dos registros de meningite no estado de Mato Grosso, analisado sob condições de vulnerabilidade, a partir de análise espacial. Metodologia: casos de meningite e população estimada foram coletados no DataSUS, sendo organizados por município de residência no estado de Mato Grosso e ano de notificação. Taxas de incidência foram calculadas a partir da divisão do número de casos pela população, multiplicando o resultado por 100.000. Para análise de autocorrelação espacial, foram utilizadas taxas médias para todo o período, além das variáveis percentual de pobres, percentual da população que vive em domicílios com banheiro e água encanada e Índice de Desenvolvimento Humano Municipal ­ Renda (IDHM Renda), obtidas junto ao Atlas de Desenvolvimento Humano no Brasil. Resultados: de uma forma geral, observou-se autocorrelação inversa quanto à variável percentual da população que vive em domicílios com banheiro e água encanada, com municípios do centro e do sudeste do estado sob autocorrelação alto-alto e municípios do noroeste e do nordeste, sob baixo-baixo. Quanto ao IDHM Renda, municípios do centro apresentaram autocorrelação alto-alto e municípios do sul e noroeste, baixo-baixo. Conclusão: o cenário sugere que há subnotificação de casos de meningite em Mato Grosso, pois situações marcadas por condições socioeconômicas menos privilegiadas são fatores de risco para transmissão da doença. Sugere-se aprimoramento de serviços de saúde, buscando políticas públicas equânimes que visem reduzir as desigualdades existentes neste pa

Enfermedad neumocócica invasiva en pacientes de un hospital pediátrico de Perú, 2017-2020 / Invasive pneumococcal disease in patients from a pediatric hospital in Peru, 2017-2020

El propósito del presente estudio fue describir las características clínicas, serotipos y susceptibilidad antibiótica en pacientes con enfermedad neumocócica invasiva (ENI). Se revisaron las historias clínicas de los pacientes con ENI hospitalizados en el Instituto Nacional de Salud del Niño-Breña (Lima, Perú). Se evaluaron a 29 pacientes. La mediana de edad fue 1,9 años (rango intercuartílico 1 a 4 años). El 51,7% eran mujeres y la forma clínica de la ENI más frecuente fue la bacteriemia en 18 (62,1%) pacientes. El 65,5% tenía el esquema de vacunación completo, según el Ministerio de Salud de Perú. El 82,8% del aislamiento del germen fue de sangre. La resistencia antibiótica fue más frecuente a la eritromicina (55,2%), trimetoprim-sulfametoxazol (48,3%) y penicilina (24,1%). Los serotipos registrados fueron 6C, 19A, 23A y 24F. Un paciente falleció por meningitis. En conclusión, la ENI fue más frecuente en niños de uno a cinco años y en la forma clínica de bacteriemia. Se encontraron cinco serotipos reportados en estudios previos con resistencia a penicilina y eritromicina.

This study aimed to describe the clinical characteristics, serotypes, and antibiotic susceptibility in patients with invasive pneumococcal disease (IPD). The medical records of patients with IPD who were hospitalized at the Instituto Nacional de Salud del Niño-Breña (Lima, Peru) were reviewed. We evaluated 29 patients. The median age was 1.9 years (interquartile range: 1 to 4 years). Of the sample, 51.7% were women and the most frequent clinical form of IPD was bacteremia in 18 (62.1%) patients; 65.5% had a complete vaccination schedule, according to the Peruvian Ministry of Health. Germ isolation was performed from blood samples in 82.8% of patients. Antibiotic resistance to erythromycin (55.2%) was the most frequent, followed by resistance to trimethoprim-sulfamethoxazole (48.3%) and penicillin (24.1%). The isolated serotypes were 6C, 19A, 23A and 24F. One patient died of meningitis. In conclusion, IPD was more frequent in children aged one to five years and the most frequent clinical form was bacteremia. Five serotypes reported in previous studies were found to be resistant to penicillin and erythromycin.

Reporte de enfermedades en la Ciudad de Buenos Aires hasta SE 29 / Disease report in Buenos Aires City until SE 29

Tablas que presentan el total de las notificaciones hasta la Semana Epidemiológica 29 de 2022, finalizada el 23 de julio, por grupo de evento: Meningitis y Meningoencefalitis; Otras; y Zoonóticas y por vectores. Incluye casos confirmados, probables, sospechosos, y descartados, de Enfermedades de transmisión vertical y sexual, Envenenamiento por animal ponzoñoso, Enfermedades gastroentéricas, y Hepatitis.

Reporte de enfermedades en la Ciudad de Buenos Aires hasta SE 30 / Disease report in Buenos Aires City until SE 30

Tablas que presentan el total de las notificaciones hasta la Semana Epidemiológica 30 de 2022, finalizada el 30 de julio, por grupo de evento: Meningitis y Meningoencefalitis; Otras; y Zoonóticas y por vectores. Incluye casos confirmados, probables, sospechosos, y descartados, de Enfermedades de transmisión vertical y sexual, Envenenamiento por animal ponzoñoso, Enfermedades gastroentéricas, y Hepatitis.

Reporte de enfermedades en la Ciudad de Buenos Aires hasta SE 31 / Disease report in Buenos Aires City until SE 31

Tablas que presentan el total de las notificaciones hasta la Semana Epidemiológica 31 de 2022, finalizada el 6 de agosto, por grupo de evento: Meningitis y Meningoencefalitis; Otras; y Zoonóticas y por vectores. Incluye casos confirmados, probables, sospechosos, y descartados, de Enfermedades de transmisión vertical y sexual, Envenenamiento por animal ponzoñoso, Enfermedades gastroentéricas, y Hepatitis.

Reporte de enfermedades en la Ciudad de Buenos Aires hasta SE 32 / Disease report in Buenos Aires City until SE 32

Tablas que presentan el total de las notificaciones hasta la Semana Epidemiológica 32 de 2022, finalizada el 13 de agosto, por grupo de evento: Meningitis y Meningoencefalitis; Otras; y Zoonóticas y por vectores. Incluye casos confirmados, probables, sospechosos, y descartados, de Enfermedades de transmisión vertical y sexual, Envenenamiento por animal ponzoñoso, Enfermedades gastroentéricas, y Hepatitis.

Reporte de enfermedades en la Ciudad de Buenos Aires hasta SE 24 / Disease report in Buenos Aires City until SE 24

Tablas que presentan el total de las notificaciones hasta la Semana Epidemiológica 24 de 2022, finalizada el 18 de junio, por grupo de evento: Meningitis y Meningoencefalitis; Otras; y Zoonóticas y por vectores. Incluye casos confirmados, probables, sospechosos, y descartados, de Enfermedades de transmisión vertical y sexual, Envenenamiento por animal ponzoñoso, Enfermedades gastroentéricas, y Hepatitis.

Reporte de enfermedades en la Ciudad de Buenos Aires hasta SE 25 / Disease report in Buenos Aires City until SE 25

Tablas que presentan el total de las notificaciones hasta la Semana Epidemiológica 25 de 2022, finalizada el 25 de junio, por grupo de evento: Meningitis y Meningoencefalitis; Otras; y Zoonóticas y por vectores. Incluye casos confirmados, probables, sospechosos, y descartados, de Enfermedades de transmisión vertical y sexual, Envenenamiento por animal ponzoñoso, Enfermedades gastroentéricas, y Hepatitis.

Reporte de enfermedades en la Ciudad de Buenos Aires hasta SE 26 / Disease report in Buenos Aires City until SE 26

Tablas que presentan el total de las notificaciones hasta la Semana Epidemiológica 26 de 2022, finalizada el 2 de julio, por grupo de evento: Meningitis y Meningoencefalitis; Otras; y Zoonóticas y por vectores. Incluye casos confirmados, probables, sospechosos, y descartados, de Enfermedades de transmisión vertical y sexual, Envenenamiento por animal ponzoñoso, Enfermedades gastroentéricas, y Hepatitis.

Reporte de enfermedades en la Ciudad de Buenos Aires hasta SE 27 / Disease report in Buenos Aires City until SE 27

Tablas que presentan el total de las notificaciones hasta la Semana Epidemiológica 27 de 2022, finalizada el 9 de julio, por grupo de evento: Meningitis y Meningoencefalitis; Otras; y Zoonóticas y por vectores. Incluye casos confirmados, probables, sospechosos, y descartados, de Enfermedades de transmisión vertical y sexual, Envenenamiento por animal ponzoñoso, Enfermedades gastroentéricas, y Hepatitis.

Reporte de enfermedades en la Ciudad de Buenos Aires hasta SE 28 / Disease report in Buenos Aires City until SE 28

Tablas que presentan el total de las notificaciones hasta la Semana Epidemiológica 28 de 2022, finalizada el 16 de julio, por grupo de evento: Meningitis y Meningoencefalitis; Otras; y Zoonóticas y por vectores. Incluye casos confirmados, probables, sospechosos, y descartados, de Enfermedades de transmisión vertical y sexual, Envenenamiento por animal ponzoñoso, Enfermedades gastroentéricas, y Hepatitis

Idiopathic Hypertrophic Spinal Pachymeningitis: A Case Report / Paquimeningite hipertrófica idiopática espinhal: Relato de caso

Abstract Idiopathic hypertrophic pachymeningitis is rare cause of neurological symptoms with myelopathy due to spinal cord compression. We report a case of pachymeningitis, which was manifested primarily by tetraparesis after low-energy trauma and recurrence the myelopathy symptoms after 5 years of surgery. The patient, a 19-year-old woman, was subjected to extensive investigation without evidence of any underlying disease. A meningeal biopsy was performed and showed an unspecific inflammatory process with extensive fibrosis of the dura mater. These findings, associated with the exclusion of other causes, suggest idiopathic hypertrophic pachymeningitis.

Resumo A paquimeningite hipertrófica idiopática é uma causa rara de sintomas neurológicos apresentando mielopatia por compressão da medula espinhal. Relatamos um caso de paquimeningite com manifestação primária de tetraparesia após trauma de baixa energia e recorrência dos sintomas de mielopatia 5 anos após a cirurgia. A paciente, uma mulher de 19 anos, foi submetida a extensa investigação sem evidências de qualquer doença de base. Uma biópsia da meninge revelou processo inflamatório inespecífico com extensa fibrose da dura máter, também visualizado no período perioperatório. Esses achados, associados à exclusão de outras causas, sugerem o diagnóstico de paquimeningite hipertrófica idiopática.

Acompanhamento do comportamento do HIV através de exames laboratoriais em portadora do vírus: relato de caso / Monitoring of HIV behavior through laboratory tests in a virus carrier: case report

O vírus da imunodeficiência humana é o agente etiológico da AIDS, doença crônica que destrói o sistema imunológico e é caracterizada pela baixa contagem de células TCD4, alta contagem de partículas virais no sangue e manifestações clínicas da doença. O diagnóstico se dá com o aparecimento de infecções oportunistas, que levam a contagem de TCD4 a níveis menores que 200 céls/mm³. Os exames laboratoriais para o diagnóstico do HIV foram os principais avanços para o início do tratamento, reduzindo a transmissão. Detecção de anticorpos, detecção de antígenos e amplificação do genoma do vírus são alguns dos exames laboratoriais utilizados para diagnóstico. Os dois principais biomarcadores são os exames de contagem de células TCD4, que verifica o sistema imune, e a quantificação de carga viral, que informa a quantidade de partículas virais, mostrando a progressão da infecção. Quanto maior a carga viral, maior o dano ao sistema imune. Uma carga viral indetectável é inferior a 50 cópias/mL, mas valores menores ou iguais a 200 cópias/mL também impedem a transmissão. Uma declaração de consenso afirma que Indetectável é igual a Intransmissível. Portanto, quando indetectável, a transmissão inexiste. O presente estudo relata e discute o caso clínico de uma paciente diagnosticada com HIV/AIDS aos 28 anos, que sobreviveu, apesar do diagnóstico tardio, e sob presença de doença oportunista com um grave grau de diminuição de células TCD4 (22 cél/mm³). Por meio do diagnóstico, introdução e adesão correta da terapia antirretroviral e monitorização de exames laboratoriais, conseguiu evitar a morte e ter uma vida semelhante à de um HIV negativo. Ultrapassou a expectativa de vida que na descoberta era de 10 anos, com uma qualidade de vida considerável, não sendo transmissora do vírus, diminuindo assim o estigma e preconceito. O biomédico é peça fundamental nesse contexto, considerando que deve fornecer informações precisas e fidedignas, tão necessárias ao acompanhamento de pessoas vivendo com HIV, para que autoridades e profissionais de saúde adotem medidas adequadas, tanto na prevenção, quanto no diagnóstico e monitoramento da doença.

The human immunodeficiency virus is the etiological agent of AIDS, a chronic disease that destroys the immune system and is characterized by low TCD4 cell count, high viral particle count in blood and clinical manifestations of the disease. The diagnosis is due to the appearance of opportunistic infections, which lead to TCD4 counts below 200 cells / mm³. Laboratory tests for the diagnosis of HIV were the main advances in starting treatment, reducing transmission. Antibody detection, antigen detection and virus genome amplification are some of the laboratory tests used for diagnosis. The two main biomarkers are the TCD4 cell count tests, which checks the immune system, and viral load quantification, which reports the number of viral particles, showing the progression of infection. The higher the viral load, the greater the damage to the immune system. An undetectable viral load is less than 50 copies / mL, but values less than or equal to 200 copies / mL also prevent transmission. A consensus statement states that Undetectable equals Non-Transmissible. Therefore, when undetectable, transmission does not exist. The present study reports and discusses the clinical case of a patient diagnosed with HIV / AIDS at age 28, who survived despite late diagnosis and under the presence of opportunistic disease with a severe degree of TCD4 cell reduction (22 cells / mm³). Through the diagnosis, introduction and correct adherence of antiretroviral therapy and monitoring of laboratory tests, she was able to avoid death and have a life similar to that of an HIV negative. Exceeded the life expectancy that in the discovery was 10 years, with a considerable quality of life, not transmitting the virus, thus reducing the stigma and prejudice. The biomedical is a key player in this context, considering that he must provide accurate and reliable information, which is so necessary for the monitoring of people living with HIV, so that authorities and health professionals adopt appropriate measures, both in prevention, diagnosis and monitoring of the disease.

Reporte de enfermedades en la Ciudad de Buenos Aires hasta SE 20 / Disease report in Buenos Aires City until SE 20

Tablas que presentan el total de las notificaciones hasta la Semana Epidemiológica 20 de 2022, finalizada el 21 de mayo, por grupo de evento: Meningitis y Meningoencefalitis; Otras; y Zoonóticas y por vectores. Incluye casos confirmados, probables, sospechosos, y descartados, de Enfermedades de transmisión vertical y sexual, Envenenamiento por animal ponzoñoso, Enfermedades gastroentéricas, y Hepatitis.