Prevalence of Mycobacterium avium and Mycobacterium tuberculosis in blood cultures of Brazilian AIDS patients after introduction of highly active retroviral therapy

The use of highly active antiretroviral therapy (HAART) for the treatment of HIV infection has been associated with a marked reduction in the incidence of most opportunistic infections. From April 2001 to February 2002, 80 blood samples from patients who were suspected to have disseminated mycobacterial infection, presenting fever and (preferably) a CD4 T cell count < 100.0 cell/mL were investigated. Twelve (15 percent) of the 80 blood cultures were positive for mycobacteria, with Mycobacterium avium being identified in 7 (8.8 percent) samples and M. tuberculosis in 5 (6.2 percent). The TCD4+ count at the time of M. avium bacteremia ranged from 7cells/æL (average of 48.5 cell/æL), while in M. tuberculosis bacteremia it ranged from 50.0 cells/æL (average of 80.0 cell/æL). The prevalence of M. avium bacteremia in our study follows the expected decline in opportunistic infections observed after the introduction of HAART; however, mycobacteremia by M. tuberculosis still indicates a high prevalence of tuberculosis infection in AIDS patients.

Varicella-zoster virus encephalitis in an AIDS patient

A 37-year-old man with a three-year history of Acquired Immunodeficiency Syndrome was admitted with impaired consciousness, seizures and fever. He was on highly active antiretroviral therapy and on neurotoxoplasmosis secondary prophylaxis. Laboratory exams from two months before showed a CD4 cell count of 37/µL and a viral load of 230,000 copies/mL. Three months before admission he developed herpetic skin rash in the right trunk and acyclovir was added to his treatment regimen. On physical exam he was drowsy and had motor and sensory aphasia. The patient had elevated protein levels and normal pressure in the cerebrospinal fluid (CSF). Contrast enhanced computed tomography scan of the brain showed a hypodense lesion in the left parietal lobe, with poorly defined margins and no contrast enhancement. The magnetic resonance scan (MRI) showed multiple hyperintensities in T2-weighted image in white and grey matters and hypointense products of hemorrhage in both hemispheres and in the cerebellum. He was empirically treated with intravenous acyclovir and prednisone. Viral DNA of Varicella-zoster virus (VZV) was detected in the CSF by means of polymerase chain reaction (PCR) analysis. Acyclovir was continued for 10 days and the patient became well, with improvement of aphasia.We present a case of VZV encephalitis, confirmed by nested PCR, in a patient with suggestive MRI findings, who succeeded with treatment. VZV encephalitis is a rare opportunistic infection, occurring in 0.1 to 4 percent of AIDS patients with neurological disease; it is related to severe immunodeficiency and has a high mortality.

Quadril em observacao: avaliacao clinico-radiologica. / \"Observation hip\": clinic-radiological evaluation

Os prontuarios de 26 pacientes atendidos com o diagnostico de "quadril em observacao" no periodo de 1975 a 1982, no Hospital de Criancas Cesar Pernetta e Clinica de Fraturas e Ortopedia XV, foram analisados. O termo "quadril em observacao" foi usado para especificar uma sindrome inicial que evolui para afeccoes com historia natural e prognostico diferentes. Em nossa serie, sinovite transitoria, doenca de Perthes, poliomielite anterior aguda e artrite septica do quadril estiveram relacionadas com o diagnostico inicial de "quadril em observacao". O trauma esteve relacionado com o aparecimento dos sintomas em 46% dos pacientes, sendo considerado o provavel agente etiologico. No exame radiografico foram avaliados o angulo cervicodiafissario, o indice de esfericidade de Mose e as sombras das partes moles. Ao final do estudo, um protocolo de atendimento para pacientes com o diagnostico sindromico de "quadril em observacao" e sugerido pelos autores