Herpes genital crônico: relato de caso e revisão da literatura / Chronic genital herpes: case report and literature review

Úlceras genitais são manifestações clínicas de etiologias diversas, o que pode dificultar o diagnóstico. Este relato de caso trata­se de mulher de 64 anos, com histórico de úlcera genital dolorosa há 4 meses, progressiva apesar do uso prévio de antiviral. Apresentava lesão ulcerada com comprometimento perianal. Histopatológico revelou neovascularização, edema e infiltrado inflamatório. Realizou tratamento com aciclovir endovenoso por 14 dias, com melhora parcial. O herpes simples crônico manifesta­se como verruga ou úlcera de pelo menos um mês, geralmente em imunossuprimidas. A resistência a agentes antivirais é uma complicação encontrada, mas a resposta ao tratamento costuma ser mais lenta do que nas infecções comuns.

Genital ulcers are clinical manifestations of diverse etiologies, which can make diagnosis difficult. This case report is about a 64­year­old woman with a history of progressive genital ulcer pain for 4 months, despite prior antiviral use. The ulcerated lesion showed perianal involvement. Histopathology revealed neovascularization, edema and inflammatory infiltrate. Despite the use of intravenous acyclovir for 14 days, the improvement was partial. Chronic herpes simplex reveals wart or ulcer of at least one month, usually in immunosuppressed patients. A resistance to antiviral agents is a complication factor, but the treatment response to common infections is usually slower.

Patients with severe accidental tetanus admitted to an intensive care unit in Northeastern Brazil: clinical-epidemiological profile and risk factors for mortality

Abstract Introduction Tetanus, an acute infectious disease, is highly prevalent worldwide, especially in developing countries. Due to respiratory failure and hemodynamic instability associated with dysautonomia, severe cases require intensive care, but little has been published regarding the management in the Intensive Care Unit. Objective To draw a 10-year clinical–epidemiological profile of Intensive Care Unit patients with severe tetanus, observe their evolution in the Intensive Care Unit and identify risk factors for mortality. Methods In this retrospective study, we used a standardized questionnaire to collect information from the records of patients with severe tetanus admitted to the intensive care unit of a referral hospital for infectious and contagious diseases in Northeastern Brazil. Results The initial sample included 144 patients, of whom 29 were excluded due to incomplete information, leaving a cohort of 115 subjects. The average age was 49.6 ± 15.3 years, most patients had no (or incomplete) vaccination against tetanus, and most were male. The main intensive care-related complications were pneumonia (84.8%) and dysautonomia (69.7%). Mortality (44.5%) was higher than expected from the mean APACHE II score (11.8), with shock/multiple organ failure as the main cause of death (72.9%). The independent factors most predictive of mortality were APACHE II score, dysautonomia, continuous neuromuscular blockade and age. Conclusion A high mortality rate was observed in our cohort of Intensive Care Unit patients with severe tetanus and a number of risk factors for mortality were identified. Our results provide important insights for the development of intervention protocols capable of reducing complications and mortality in this patient population.