RESUMO
ABSTRACT In 2022, an outbreak of monkeypox is being reported in non-endemic areas, with unusual clinical manifestations. The detailed clinical description of the first patient that received the diagnosis of monkeypox in Brazil is reported here, whose clinical manifestations can easily lead to misdiagnosis of sexually transmitted infections. A 41 years old male presented to an emergency room with a vesicular rash with eight days of evolution. He had traveled to Portugal and Spain and reported non-penetrative sexual involvement with three different male individuals. On the third day of symptoms, he sought medical care and received empirical treatment directed to sexually transmitted infections. As the symptoms did not improve, he sought medical attention at an infectious disease referral center presenting, on admission, an ulcerated penile lesion with central necrotic crusts, a disseminated pleomorphic skin rash and an oropharyngeal ulcer. The monkeypox diagnosis was suspected due to the characteristics of the lesions and the history of intimate contact with casual partners, and it was later confirmed by sequencing the almost complete monkeypox genome. The patient was hospitalized for pain control, which required opiate administration. He developed a secondary bacterial infection on the penile lesions, which were treated with oral antibiotics. He was discharged after 14 days, with lesions in process of re-epithelialization. Given the current outbreak, we must consider the possibility of monkeypox in patients with suggestive lesions, anywhere on the body (including the genitals), added to an epidemiological link or history of intimate contact with strangers or casual partners.
RESUMO
ABSTRACT Monkeypox virus (MPXV), a zoonotic virus endemic to the African continent, has been reported in 33 non-endemic countries since May 2022. We report an almost complete genome of the first confirmed case of MPXV in Brazil. Shotgun metagenomic sequencing was completed in 18 hours, from DNA extraction to consensus sequence generation.
RESUMO
Streptococcus pneumoniae é o agente causal mais comum de pneumonias bacterianas e bacteremias nao micobacterianas em indivíduos infectados pelo HIV, estimando-se que esses pacientes sejam de 100 a 300 vezes mais susceptíveis à doença pneumocóccica invasiva, se comparados a indivíduos nao infectados pelo HIV. Desde 1989 o Centers for Disease Control and Prevention, EUA indica a vacina pneumocócia 23-valente na populaçao HIV+. No entanto, vários estudos encontraram uma resposta diminuída à vacinaçao nesta populaçao, principalmente nos indivíduos imunossuprimidos. Em contrapartida, outros estudos observaram respostas semelhantes aos controles normais, sendo sua indicaçao ainda polêmica. Realizamos a dosagem de anticorpos contra polissacarídeos capsulares de Streptococcus pneumoniae sorotipos 1, 3, 5, 6B, 9V e 14 antes e após imunizaçao com vacina pneumocócica 23-valente de 15 indivíduos voluntários normais HIV-e de 42 indivíduos HIV+, distribuídos em três grupos pela contagem de LTCD4+ (Grupo I > 500 células/mm3, Grupo II entre 200 e 499 células/mm3 e Grupo III < 200 células/mm3). Observamos que os títulos de anticorpos contra os polissacarídeos capsulares do Streptococcus pneumoniae, antes da vacinaçao, sao semelhante entre os indivíduos normais e os portadores do vírus HIV, independentemente do grau de imunodepressao. Verificamos também que a resposta à imunizaçao com a vacina pneumocócica 23-valente, aos antígenos capsulares dos sorotipos testados, é semelhante entre os controles normais e os indivíduos HIV+, mesmo nos pacientes com LTCD4+ < 200 céls/mm3, independentemente do uso de anti-retrovirais. Nenhum dos grupos respondeu de forma adequada, ao sorotipo 3; o sorotipo que induziu a melhor resposta em todos os grupos foi o 14.