An Unresolving Case of Pyomyositis: A Case Report

@#Pyomyositis which is also known as myositis tropicans is a rare condition where there is bacterial infection of the skeletal muscle. Its manifestation includes pain and tenderness of the affected muscle and general infective symptoms. It commonly occurs in immunocompromised individuals and patients with previous history of trauma to the affected muscle. We report a case of a 16-year-old boy with history of underlying bronchial asthma who presented with multiple abscesses. He underwent multiple operations to drain the infection and targeted antibiotic therapy subsequently. Despite undergoing surgical debridement, drainage and antibiotic treatment, he was still having repeated bouts of fever and his inflammatory markers were not reducing. He was then diagnosed with concurrent pulmonary tuberculosis infection which subjected him to an immunosuppressed state thus arising to the condition of pyomyositis and unresolving fever. The patient then made prompt improvement when the underlying cause of immunosuppression; pulmonary tuberculosis was treated as well.

Factores de riesgo de bacteriemia en niños con cáncer y neutropenia febril / Risk factors for bacteremia in children with cancer and febrile neutropenia

La bacteriemia representa una importante causa de morbimortalidad en pacientes oncológicos. Durante el episodio de neutropenia inducida por quimioterapia, un 15%­25% de los pacientes tendrá bacteriemia. Objetivo: identificar factores de riesgo asociados con bacteriemia en pacientes oncológicos pediátricos con neutropenia y fiebre. Material y métodos: estudio de cohorte prospectivo. Se incluyeron pacientes con enfermedades hematooncológicas y neutropenia febril, internados en un hospital pediátrico de alta complejidad entre julio de 2018 y mayo de 2019. Se excluyeron receptores de trasplante de médula ósea. Se compararon las características clínicas según se documentara bacteriemia (B) o no. Resultados: Se incluyeron 160 pacientes (p). Eran varones 93 (58%). La mediana de edad fue 81,5 meses (RIC 36-127,5). La enfermedad de base (EB) más frecuente fue: leucemia linfoblástica aguda (LLA) 88 (55%). Se identificaron 20 (12,5%) pacientes con bacteriemia (B). En el análisis univariado hubo asociación entre B y LMA (p=0,003) y la internación en UCI (p=0,0001). En el modelo multivariado, ajustado por el resto de las variables, se identificaron la LMA (OR 8,24, IC95% 2,5-26,4; p<0,001) y la tiflitis (OR 5,86, IC95% 1,2-27,3; p=0,02) como factores relacionados con bacteriemia. Los principales microorganismos identificados fueron: estreptococos del grupo viridans 6 (30%), Escherichia coli 4 (20%) y estafilococos coagulasa negativos 3 (15%). Quince (75%) fueron bacteriemias secundarias a un foco clínico. El foco más frecuente fue el mucocutáneo (n=7, 35%). En esta cohorte de niños con cáncer y neutropenia febril, los factores asociados con bacteriemia fueron: la LMA, la tiflitis y la internación en UCI (AU)

Bacteremia is an important cause of morbidity and mortality in oncology patients. During an episode of chemotherapy-induced neutropenia, 15%-25% of patients will develop bacteremia. Objective: to identify risk factors associated with bacteremia in pediatric oncology patients with neutropenia and fever. Material and methods: prospective cohort study. Patients with hematology-oncology diseases and febrile neutropenia, admitted to a tertiary-care pediatric hospital between July 2018 and May 2019 were included. Bone marrow transplant recipients were excluded. Clinical characteristics were compared according to whether or not bacteremia was recorded. Results: 160 patients were included of whom 93 (58%) were male. Median age was 81.5 months (IQR 36-127.5). The most common underlying disease was acute lymphoblastic leukemia (ALL) in 88 patients (55%). Twenty (12.5%) patients with bacteremia were identified. In univariate analysis, an association was found between bacteremia and acute myeloid leukemia (AML) (p=0.003) and ICU admission (p=0.0001). In the multivariate model, adjusted for the remaining variables, AML (OR 8.24; 95%CI 2.5-26.4; p<0.001) and typhlitis (OR 5.86; 95%CI 1.2-27.3; p=0.02) were identified as factors related to bacteremia. The main microorganisms identified were viridans group streptococci in 6 (30%), Escherichia coli in 4 (20%), and coagulase negative staphylococci in 3 (15%). In 15 cases (75%), bacteremia was secondary to a clinical focus. The most frequent focus was mucocutaneous (n=7, 35%). In this cohort of children with cancer and febrile neutropenia, the factors associated with bacteremia were AML, typhlitis, and ICU admission (AU)

Infección grave diseminada por adenovirus en receptores de trasplante hepático / Severe adenovirus infections in hepatic transplant recipients / Infecção grave por adenovírus disseminado em receptores de transplante de fígado

Resumen: Los adenovirus humanos continúan siendo un desafío en la práctica clínica, se trata de virus de tipo ADN, con amplia distribución en la población, causa frecuente de enfermedad autolimitada en niños. Sin embargo, en pacientes inmunosuprimidos, principalmente trasplantados de células hematopoyéticas y de órganos sólidos, puede llegar a ser causa de enfermedad diseminada severa, con elevada morbimortalidad. Compartimos el primer reporte nacional de enfermedad por adenovirus diseminado, en el que se presentan dos casos clínicos de pacientes trasplantados hepáticos, que desarrollan enfermedad diseminada grave por adenovirus. Se realiza una revisión de la literatura sobre el tema.

Abstract: Human adenoviruses still constitute a challenge in the clinical practice. These are DNA viruses that are widely disseminated among the population and often cause self-limiting diseases in children. However, it may result in a severe diseminated disease with high morbi-mortality rates in immunocompromised patients, in particular transplant recipients of hematopoietic cells and solid organs. The study shares the first national report for disseminated adenovirus disease, presenting two clinical cases of hepatic transplant recipients who developed severe disseminated adenovirus disease. And conducting a literature review on the topic.

Resumo: Os adenovírus humanos continuam sendo um desafio na prática clínica; são vírus do tipo DNA, com ampla distribuição na população, causa frequente de doença autolimitada em crianças. Entretanto, em pacientes imunossuprimidos, principalmente receptores de transplante de células hematopoiéticas e órgãos sólidos, pode se tornar causa de doença disseminada grave, com alta morbimortalidade. Este é o primeiro relato nacional de doença de adenovírus disseminado, no qual são apresentados dois casos clínicos de pacientes transplantados de fígado que desenvolvem doença de adenovírus disseminada grave. Realizou-se também revisão da literatura sobre o assunto.

Persistently positive PCR SARS-CoV-2 at low cycle threshold in an immunosuppressed patient

ABSTRACT We describe the very prolonged course of the disease in an immunosuppressed patient with persistently positive PCR against SARS-CoV-2 with low cycle threshold for at least 114 days.

Evaluación microbiológica del caudal de impulsión y extracción mecánica en habitaciones hospitalarias de aislados infecciosos e inmunodeprimidos / Microbiological evaluation of the discharge flow and mechanical extraction in hospital rooms of infectious and immunosuppressed isolates

Por las particularidades de los hospitales, su entorno contiene un gran número de microorganismos proporcionando condiciones muy favorables para la reproducción y la propagación de microorganismos patógenos. Por otro lado, como un sitio importante del uso de antibióticos, las infecciones asociadas a hospitales y la resistencia a los antimicrobianos promueven mutuamente la formación de un círculo vicioso. Existen fuertes evidencias de que la transmisión por aire y aerosoles de los microorganismos patógenos están muy extendidos en los entornos hospitalarios. En ese sentido, las partículas transportadas por el aire se caracterizan por su baja densidad, invisibilidad y susceptibilidad a la turbulencia. El asentamiento de partículas infecciosas en el aire sobre la herida de un paciente puede causar infecciones en cirugía o en caso más graves, infectar a pacientes con sistemas inmunológicos comprometidos, o puede conducir, si las condiciones de ventilación no son apropiadas, a la diseminación de bacterias y hongos (bioaerosoles) desde pacientes infecciosos a toda la comunidad hospitalaria. Para mejorar el estado de estas infecciones asociadas a los hospitales, los sistemas tradicionales se han centrado en estrategias para eliminar patógenos presentes en pacientes, superficies clínicas y trabajadores de la salud, que ha impulsado la implementación de varios protocolos de control y desinfección de infecciones que también han tenido éxito en la reducción de la incidencia de este tipo de infecciones hospitalarias. Dentro de estos procedimientos, está el uso de sistema de ventilación con presión de aire positiva o negativa El objetivo de este trabajo es determinar la capacidad de control microbiano de los sistemas de ventilación en dos centros de asistencia médica del Perú en habitaciones con pacientes inmunosuprimidos (VIH/Sida) aislados o en habitaciones de pacientes infecciosos(AU)

Due to the particularities of hospitals, their environment contains a large number of microorganisms, providing very favorable conditions for the reproduction and spread of pathogenic microorganisms. On the other hand, as an important site of antibiotic use, hospital-associated infections and antimicrobial resistance mutually promote the formation of a vicious circle. There is strong evidence that airborne and aerosol transmission of pathogenic microorganisms is widespread in hospital settings. In that sense, airborne particles are characterized by their low density, invisibility, and susceptibility to turbulence. The settling of airborne infectious particles on a patient's wound can cause infections in surgery or, in more serious cases, infect patients with compromised immune systems, or can lead, if ventilation conditions are not appropriate, to the spread of pathogens. bacteria and fungi (bioaerosols) from infectious patients to the entire hospital community. To improve the status of these hospital-associated infections, traditional systems have focused on strategies to eliminate pathogens present in patients, clinical surfaces, and healthcare workers, which has prompted the implementation of various infection control and disinfection protocols that they have also been successful in reducing the incidence of this type of hospital infection. Within these procedures, there is the use of a ventilation system with positive or negative air pressure. The objective of this work is to determine the microbial control capacity of the ventilation systems in two medical care centers in Peru in rooms with immunosuppressed patients (HIV/AIDS) isolated or in infectious patient rooms(AU)

Ectima gangrenoso en el paciente inmunocomprometido: debut leucemia aguda

El Ectima gangrenoso es un trastorno infeccioso infrecuente, clásicamente relacionado a bacteriemia, descrito principalmente en poblaciones inmunodeprimidas. Se asocia con la sepsis y bacteriemia por P. aeruginosa en pacientes inmunodeprimidos, incluidos aquellos con neutropenia o inmunodeficiencias, también se han descrito casos por hongos filamentosos y levaduras. Se ha observado en aproximadamente un 1,3-3 % de los casos de bacteriemia por P. Aeruginosa1. Se ha descrito ectima en pacientes con déficit en su inmunidad2, como en el caso que se describe a continuación. El Ectima puede presentarse como lesión única o múltiple, caracterizadas por máculas eritematosas que progresan a vesículas, bullas o pústula, evolucionando hasta la necrosis central con halo eritematoso. Se presenta el caso de un paciente con Ectima Gangrenoso, refractario inicialmente a tratamiento, que evolucionó con empeoramiento progresivo, presentándose en el hemograma hiperleucocitosis asociado a anemia y trombopenia, con diagnóstico ulterior de Leucemia Mieloide Aguda.

Ecthyma gangrenosum is an uncommon infectious disorder classically associated with bacteremia and found mainly in immunocompromised populations. It is associated with sepsis and Pseudomonas aeruginosa bacteremia in immunocompromised patients, including those with neutropenia or immune deficiencies. There have also been cases caused by filamentous fungi and yeasts. It has been seen in approximately 1.3 ­ 3% of Pseudomonas aeruginosa bacteremias. Ecthyma has been reported in immune-deficient patients, as in the case described below. Ecthyma can present with a single or multiple lesions with erythematous macules progressing to vesicles, bullas or pustules, which develop central necrosis with an erythematous halo. We present the case of a patient, later diagnosed with Acute Myeloid Leukemia, with ecthyma gangrenosum, initially refractory to treatment, which worsened progressively, presenting hyperleukocytosis associated with anemia and thrombocytopenia in the whole blood count.

Neumonía por Pneumocystis Jirovecii en paciente adolescente inmunosuprimido no VIH positivo: Un reporte de caso / Pneumocystis Jirovecii pneumonia in a non-HIV immunosuppressed adolescent patient: A case report

Resumen La neumonía en el paciente inmunocomprometido es un reto diagnóstico al cual el clínico se enfrenta cada vez con más frecuencia , al momento de hablar de infiltrados en vidrio esmerilado es menester tener siempre en cuenta la posibilidad de neumonía por Pneumocystis Jirovecii, que por mucho tiempo se pensó como una enfermedad propia del huésped inmunosuprimido con VIH, a través del tiempo se ha manifestado en pacientes con trasplantes de órgano sólido y de precursores hematopoyéticos, asociado a autoinmunidad, al uso crónico de corticoesteroides y más recientemente al uso de terapia biológicas. La descripción de esta enfermedad y sus métodos diagnósticos en huéspedes inmunosuprimidos no VIH no es del todo claro, sabemos que el tratamiento de elección en estos casos es el trimetropin-sulfametoxazol (TMP-SMX) el cual no cuenta con evidencia de alta calidad al momento de plantear una dosis ni un tiempo de duración establecidos. Presentamos el caso de un paciente con diagnóstico de glomerulonefritis por enfermedad de cambios mínimos corticodependiente y quien desarrolló neumonía por Pneumocystis Jirovecii confirmada por histopatología quien recibió tratamiento y tuvo un desenlace positivo.

Abstract The pneumonia in the immunocompromised patient is a diagnostic challenge that the clinician faces more and more frequently, every time we talk about ground glass infiltrates it is necessary to always take into account the possibility of pneumonia due to Neumocystis Jirovecii, which for a long time was thought as a disease of the immunosuppressed host with HIV, but that across the time it has manifested itself in patients with solid organ transplants and hematopoietic precursors, associated with autoimmunity, the chronic use of corticosteroids and more recently the use of biological therapy. The description of this disease and the diagnostic methods in non-HIV immunosuppressed hosts is not entirely clear, we know that the treatment of choice in these cases is trimethropin-sulfamethoxazole (TMP-SMX), which does not have high-quality evidence at the time of a dose or a time of established duration. We present the case of a patient diagnosed with glomerulonephritis due to corticodependent minimal change disease and who suffers from pneumocystis Jirovecii pneumonia confirmed by histopathology, which received treatment and had a positive outcome

Acanthus ilicifolius L. Treatment for Oral Candidiasis with Immunosuppressive Conditions Subjected to p38 MAPK Enhancement

ABSTRACT@#Methanolic extract from the leaves of Acanthus ilicifolius L. (A. ilicifolius L.) is a potent inhibitor of Candida albicans (C. albicans) growth and anti-inflammatory. C. albicans causes oral candidiasis in immunosuppressive condition. Mitogen-activated protein kinase (MAPK) signalling via p38 appears to discriminate between yeast and hyphal cells of C. albicans. Activation of p38 MAPK by hyphae results in the upregulation of proinflammatory cytokines. The p38 MAPK activation is known to impair corticosteroid action. The research was conducted to investigate the effect of methanolic extract A. ilicifolius L. treatment of oral candidiasis with the immunosuppressive condition through enhancement of p38 MAPK expression in the epithelial cells. Immunosuppressed conditions were obtained when 16 healthy male Rattus norvergicus (Wistar) was given oral administration of dexamethasone and tetracycline for 14 days and induced with C. albicans (ATCC-10231) 1 McFarland. The subjects were divided into four groups (n = 4/group): immunosuppression (IS), immunosuppression with oral candidiasis without treatment (ISC), immunosuppression with oral candidiasis and nystatin treatment (ISC+N), and immunosuppression with oral candidiasis and A. ilicifolius L. treatment (ISC+AI), and were treated for 14 days. Later, the rats were euthanised, and their tongue were biopsied. The p38 MAPK expression was subjected to immunohistochemical examination, observed under a microscope (400× magnification) and statistically analysed (one-way ANOVA, LSD-test, p < 0.05). The p38 MAPK expression of ISC+AI (36.05 ± 1.54) was higher than IS (26 ± 2.32), ISC (26.4 ± 3.71), IS+N (34.2 ± 0.99). Significant differences existed between ISC+AI and ISC+N to IS and ISC (p < 0.05). No significant differences were present between IS and ISC; ISC+AI and ISC+N (p > 0.05). Therefore, this treatment could enhance p38 MAPK expression in oral candidiasis with the immunosuppressed condition.

Hepatocellular Liver Function of Immunosuppressed Rats with Oral Candidiasis after Hyperbaric Oxygen Treatment: Alanine Transaminase and Aspartate Transaminase Levels

ABSTRACT@#Hepatocellular utility is observed by measuring the hepatocellular enzymes. Changes in its serum levels are related to liver dysfunction. Liver is one of the immunoprotective organs. Continuous use of immunosuppressive drugs can cause oral candidiasis and give effects to liver function. Hyperbaric oxygen treatment (HBOT), while reducing fungal infections, can also repair the liver function. The aim of this study was to investigate the alanine transaminase (ALT) and aspartate transaminase (AST) levels of immunosuppressed rats with oral candidiasis treated with hyperbaric oxygen. Twelve Wistar rats were divided into three groups: K− (normal/ healthy), K+ (oral candidiasis immunosuppressed rats), and P (oral candidiasis immunosuppressed rats treated hyperbaric oxygen). K+ and P groups were immunosuppressed by giving dexamethasone 0.5 mg/day/rat orally for 14 days, added with tetracycline 1 mg/day/rat. HBOT was given in five days successively. Blood serum of rats in all groups were taken to calculate the ALT and AST levels. ALT and AST levels in K+ showed higher value than K− and P groups. The data were analysed with one-way ANOVA test and showed significant difference in ALT levels (p < 0.05), while in AST levels there was no significant difference among the groups (p > 0.05). This study showed that HBOT affected the ALT and AST levels of immunosuppressed rats with oral candidiasis.

Cryptococcal Encephalitis Complicating Anti-N-methyl-D-aspartate Receptor Encephalitis in an Immunosuppressed Patient / 中国医学科学院学报

Cryptococcal encephalitis is a fatal central nervous system infectious disease,whereas anti-N-methyl-D-aspartate(NMDA)receptor encephalitis(NMDARE)is an autoimmune syndrome associated with psychological symptoms,behavioural abnormalities,seizures,and dyskinesias.Despite their distinct pathologies and pathogenic mechanisms,both of them can lead to cognitive dysfunction and abnormal behaviors,although anti-NMDARE can also have mood and mental disorders as its core manifestations.A patient with nephrotic syndrome accompanied by both cryptococcal encephalitis and anti-NMDARE was treated in our center,which for the first confirmed that these two conditions could coexist in one patient.The underlying mechanism may be similar to that of anti-NMDARE after other infections.

Galactomannan use in clinical practice: providing free testing is not the full answer

ABSTRACT Introduction: Invasive aspergillosis is a condition associated with a high mortality rate mostly due to difficulties in performing an early diagnosis. In recent years, galactomannan detection has markedly improved the diagnosis of invasive aspergillosis, but very little is known on how physicians deal with this test in clinical practice. Methods: This cross-sectional study aimed to analyze the indications for the use of serum galactomannan in a large Brazilian hospital, between 2015 and 2016. No specific protocol was in place for GM request. We reviewed the medical records of adult (>18 years-old) patients who were tested for galactomannan due to one the following indications: screening, diagnosis, or treatment follow-up. Additional variables included demographic data, underlying diseases, presence of neutropenia, and use of previous antifungal (anti-Aspergillus) drugs. Results: The mean age of the patients was 51 years-old (sd ± 15.8), and 63.3% of patients were male. Patients with hematological malignancies accounted for 60.1% of the cases, mostly acute myeloid leukemia (19.6%). Galactomannan testing was positive in 12.2% of patients, including 1.6% of occasions in which the test was used for screening purposes, 13.2% for diagnosis, and 32.4% during follow-up. Median time for chest imaging request was two days before GM testing. Previous antifungal therapy was reported for 35.1% of patients, mostly amphotericin B (57.1%). Conclusion: The correct use of galactomannan testing is essential for an early diagnosis of invasive aspergillosis, which may improve the prognosis of the disease. We demonstrated that clinicians usually ask for galactomannan tests to confirm imaging findings in patients who frequently were on antifungal drugs, something that could be improved by medical education. We observed a low frequency of galactomannan use for preemptive antifungal therapy (25.7%), which is worrying considering the well-known beneficial use of GM testing in this scenario.

Vaccination coverage in a cohort of HIV-infected patients receiving care at an AIDS outpatient clinic in Espírito Santo, Brazil

Abstract This cross-sectional study assessed the immunization status of human immune deficiency virus (HIV)-infected patients receiving care at an outpatient clinic in Brazil. The sociodemographic characteristics, CD4 count and HIV viral load of 281 out of 612 adult outpatients were analyzed. A total of 331 patients were excluded because of no availability of vaccination cards. Chi-square or Fisher's exact test were used. Immunization coverage was higher for diphtheria/tetanus (59.79%) and hepatitis B (56.7%), and lowest for hepatitis A (6.8%) and for meningococcal group C (6%). Only 11.74% of the patients had received the influenza virus vaccine yearly since their HIV-infection diagnosis. No vaccination against influenza (p < 0.034) or hepatitis B (p < 0.029) were associated with CD4 counts <500 cells/mL; no vaccination against flu or pneumococcus were associated with detectable HIV viral load (p < 0.049 and p < 0.002, respectively). Immunization coverage is still very low among HIV-infected adults in this setting despite recommendations and high infection-related mortality.

Vacina contra a febre amarela: reações adversas e populações de risco / Yellow fever vaccine: adverse reactions and at-risk populations

A febre amarela é uma doença infecciosa grave causada por um arbovírus e transmitida pelos mosquitos Haemagogus (ciclo silvestre) e Aedes aegypti (ciclo urbano). Os sintomas mais comuns são febre, calafrios, cefaleia, mialgia e náuseas. Uma parcela dos pacientes desenvolve as formas graves, que podem cursar com insuficiência hepática e renal. A partir de 2014 a febre amarela passou a ser endêmica em áreas extra-amazônicas, tornando-se um grave problema de saúde pública. Por isso, a vacinação contra a febre amarela é essencial para o controle da doença no Brasil, tornando-se a medida mais eficaz, com imunogenicidade superior a 95%. Em relação à segurança, a maioria dos eventos adversos após a vacinação são locais, e os eventos adversos graves, como a encefalite pós-vacinal, são relatados principalmente em idosos e imunossuprimidos. Por se tratar de vacina de vírus vivo atenuado, é recomendada cautela na sua indicação nesses indivíduos. Outra preocupação em relação à segurança se deve ao fato de que, por ser cultivada em ovos embrionados de galinha (maior quantidade de proteínas do ovo), a vacina febre amarela é contraindicada em indivíduos que apresentam história prévia de reação anafilática ao ovo. No entanto, diante do cenário epidemiológico atual, indivíduos com história de hipersensibilidade leve ou moderada ao ovo podem recebê-la seguindo as recomendações de segurança revisadas e sugeridas neste texto. O objetivo deste documento foi revisar as indicações e contraindicações da vacina febre amarela e apresentar uma abordagem prática em situações especiais, com a finalidade de garantir a imunização à população de risco.

Yellow fever is a serious infectious disease caused by arboviruses and transmitted by Haemagogus (wild cycle) and Aedes aegypti (urban cycle) mosquitoes. The most common symptoms are fever, chills, headache, myalgia and nausea. A subgroup of patients develops severe forms that can manifest with hepatic and renal failure. As of 2014, yellow fever has become endemic in extra- Amazonian areas, and therefore it is considered a serious public health problem. Vaccination against yellow fever is essential to control the disease in Brazil, and it is the most effective measure, with an immunogenicity above 95%. With regard to safety, most post-vaccination adverse reactions are local, and serious adverse events such as post-vaccinal encephalitis are reported mainly in the elderly and in immunocompromised hosts. Because the yellow fever vaccine is live attenuated, caution is advised in these individuals. Another concern regarding safety is the fact that the vaccine is cultured in embryonated chicken eggs (high amount of egg protein), contraindicating its use in individuals with a history of anaphylactic reaction to egg. However, in view of the current epidemiological scenario, individuals with a history of mild or moderate hypersensitivity to egg may receive the vaccine, observing the safety recommendations reviewed and suggested in this paper. The objective of this article is to review indications and contraindications of the yellow fever vaccine and present a practical approach in special situations to guarantee immunization of the population at risk.

Contaminação microbiológica em sorvetes comercializados na região Sul do Brasil

Este trabalho teve por objetivo analisar amostras de sorvete da região Sul do País para avaliar a contaminação seguindo as exigências da Agência Nacional de Vigilância Sanitária (ANVISA). As amostras foram coletadas nos estados de Paraná, Santa Catarina e Rio Grande do Sul aleatoriamente, totalizando 68 amostras durante os meses de setembro, outubro, novembro, dezembro de 2011. Para as análises seguiu-se a Resolução - RDC n° 12, de 2 de janeiro de 2001, a Instrução Normativa (IN) n° 62 de 26 de agosto de 2003, método Petrifilm (3M) e método imunoenzimático - VIDAS. Nesta pesquisa foram considerados todos resultados que indicaram contaminação e também resultados que revelaram presença de micro-organismos na amostra pelo fato de pacientes imunodeprimidos virem a consumir sorvete durante tratamento quimioterápico. Todos os resultados para Salmonella sp. apresentaram-se negativos e 83,8% das amostras estão em condições higienicossanitárias satisfatórias. Já 16,2% das amostras apresentaram contaminação por micro-organismos, sendo que 13,2% apresentaram contaminação por coliformes termo tolerantes e 3% apresentaram contaminação por Staphylococcus aureus. Na segunda análise de dados, onde considerou-se presença e contaminação, encontraram-se 76,5% das amostras em condições satisfatórias e 23,5% em condições insatisfatórias. As amostras de sorvete tipo italiano não apresentaram qualquer contaminação nos 4 meses de coleta no RS.

This study aimed to analyze ice cream samples of Southern Brazil to assess contamination following the requirements of the National Health Surveillance Agency (ANVISA). Samples were collected in the states of Parana, Santa Catarina and Rio Grande do Sul a total of 68 random samples during the months of September, October, November, December 2011. The analyzes followed the Resolution - RDC n o 12, January 2, 2001, Normative Instruction (IN) No. 62, August 26, 2003 (Published in the Official Gazette, 18/09/2003, Section 1, page 14), method, Petrifilm (3M) and enzyme immunoassay - LIVES. In this study all results were considered to indicate contamination and also results that revealed the presence of microorganisms in the sample because immuno compromised patients come to eat ice cream during chemotherapy. Ali results for Salmonella sp. shown to be negative and 83.8% of the samples are hygienic and sanitary conditions. Since 16.2% of the samples were contaminated by microorganisms, and 13.2% were contaminated by fecal coliform and 3% contamination by Staphylococcus aureus. In the second analysis data, where we consider the presence and contamination, we found 76.5% of the samples in satisfactory condition and 23.5% in poor condition. The Italian type of ice cream samples, showed no contamination in the four months of collection in RS.

Cryptococcus spp. em excretas de Columba livia (pombos domésticos) provenientes de um hospital universitário no Sul do Brasil / Cryptococcus spp. in excreta of Columba livia (domestic pigeons) from a university hospital in southern Brazil

A criptococose é uma micose primariamente pulmonar, sendo adquirida por meio de inalação de propágulos fúngicos infectantes encontrados no ambiente. Um dos principais agentes etiológicos da criptococose é a espécie Cryptococcus neoformans , que apresenta distribuição mundial. O objetivo desse trabalho foi pesquisar a ocorrência de Cryptococcus spp. em excretas de Columba livia (pombos domésticos) encontradas na área externa do prédio do Hospital Universitário Dr. Miguel Riet Correa Junior, centro de referência para o tratamento da Síndrome da Imunodeficiência Adquirida na região sul do estado do Rio Grande do Sul, Brasil. Durante um período de dez meses, foi coletado um total de 40 amostras de excretas secas da área acadêmica e da área hospitalar do Hospital Universitário. As excretas foram adicionadas de solução salina com cloranfenicol, homogeneizados em vórtex, semeados em ágar Níger e incubados a 25ºC com observações diárias até sete dias. A identificação do micro-organismo foi realizada por provas fenotípicas e bioquímicas. Das 40 amostras processadas e analisadas, 13 (32,5%) foram positivas para o isolamento de Cryptococcus spp., variando de 20.000 a 3.000.000 UFC/g de fezes. O isolamento desse fungo em um ambiente hospitalar é relevante em saúde pública, pois evidencia a exposição dos indivíduos que frequentam esse local a propágulos infectantes.(AU)

Cryptococcosis is primarily a pulmonary mycosis, being acquired by inhalation of infective fungal propagules found in the environment. One of the main etiological agents of cryptococcosis is the yeast Cryptococcus neoformans , which has worldwide distribution and whose natural habitat is the feces of birds. The aim of this study was to investigate the occurrence of Cryptococcus spp. in excreta of Columba livia (domestic pigeon) found in the outer area of the building of Hospital Universitário Dr. Miguel Riet Correa Junior, a reference center for the treatment of Acquired Immunodeficiency Syndrome in southern state of Rio Grande do Sul, Brazil. During a period of ten months, a total of 40 samples of dried excreta was collected from the site's academic area and hospital. To the excreta, were added saline solution with chloramphenicol, homogenized in a vortex, cultivated in Niger seed agar and incubated at 25°C with daily observations up to seven days. The identification of the microorganism was performed by phenotypical and biochemical tests. From the 40 samples processed and analyzed, 13 (32.5%) were positive for the isolation of Cryptococcus spp., with the quantity of yeasts ranging from 20.000 to 3.000.000 CFU/g of feces. Isolation of the opportunistic fungus Cryptococcus spp. at a university hospital is relevant in public health for demonstrating the exposure of individuals who frequent this site to infectant propagules.(AU)

Pleurotus nebrodensis polysaccharide (PN-S) enhances the immunity of immunosuppressed mice / 中国天然药物

In the present study, the effects of Pleurotus nebrodensis polysaccharide (PN-S) on the immune functions of immunosuppressed mice were determined. The immunosuppressed mouse model was established by treating the mice with cyclophosphamide (40 mg/kg/2d, CY) through intraperitoneal injection. The results showed that PN-S administration significantly reversed the CY-induced weight loss, increased the thymic and splenic indices, and promoted proliferation of T lymphocyte, B lymphocyte, and macrophages. PN-S also enhanced the activity of natural killer cells and increased the immunoglobulin M (IgM) and immunoglobulin G (IgG) levels in the serum. In addition, PN-S treatment significantly increased the phagocytic activity of mouse peritoneal macrophages. PN-S also increased the levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interferon-γ (INF-γ), and nitric oxide (NOS) in splenocytes. qRT-PCR results also indicated that PN-S increased the mRNA expression of IL-6, TNF-α, INF-γ, and nitric oxide synthase (iNOS) in the splenocytes. These results suggest that PN-S treatment enhances the immune function of immunosuppressed mice. This study may provide a basis for the application of this fungus in adjacent immunopotentiating therapy against cancer and in the treatment of chemotherapy-induced immunosuppression.

Aspergilosis nasosinusal con extensión intracraneal en una paciente inmunocompetente: una entidad infrecuente con características radiológicas típicas / Sinonasal aspergillosis with intracranial extension in an immunocompetent patient: a rare disease with typical imaging features

El aspergilo es un hongo ubicuo. Las localizaciones de infección primaria más comunes son el tracto respiratorio y los senos paranasales. La afectación intracraneal es rara y conlleva una alta mortalidad. Ocurre mayoritariamente por extensión hematógena desde el pulmón, pero en pacientes inmunocompetentes, la extensión directa desde los senos paranasales es más común. Describimos el caso de una mujer de 25 años originaria de India que se presentó en el servicio de urgencia de nuestro centro hospitalario con cefalea frontal crónica y progresiva. Los hallazgos en los estudios de imágenes sugirieron el diagnóstico de sinusitis fúngica con extensión intracraneal, siendo el patógeno más frecuente el aspergilo. El diagnóstico fue confirmado anátomo-patológicamente. Revisamos los hallazgos radiológicos típicos que deben ayudar al diagnóstico precoz de esta entidad, rara, pero potencialmente mortal.

Aspergillus is a ubiquitous fungus. The most common primary sites of infection are the respiratory tract and sinuses. Intracranial infection is rare and implies a high mortality. It occurs mainly by hematogenous extension from the lung, but in immunocompetent patients, direct extension from the sinuses is more common. We describe the case of a 25 year old woman from India who consulted in the emergency room of our hospital with chronic and progressive frontal headache. The findings in imaging studies suggested the diagnosis of fungal sinusitis with intracranial extension, being the most common pathogen of Aspergillus. The diagnosis was anatomically-pathologically confirmed. We review the typical radiological findings which should help in the early diagnosis of this rare but potentially fatal disease.

Primer caso de onicomicosis causada por Cylindrocarpon lichenicola, en un paciente inmunosuprimido en Costa Rica / First case of onychomycosis caused by Cylindrocarpon lichenicola in an immunosuppressed patient un Costa Rica

Antecedentes: la onicomicosis es una infección fúngica de las uñas, que puede ser causada por dermatofitos, levaduras y hongos filamentosos no dermatofitos. El objetivo del presente trabajo fue identificar-morfológica y molecularmente- un aislamiento realizado a partir de la uña del dedo medio de la mano derecha de un paciente inmunosuprimido con trasplante renal. Métodos: a la muestra se le realizó un examen microscópico directo en KOH 40 por ciento, y las características de la colonia fueron evaluadas en medio de cultivo Agar Sabouraud Glucosado y Agar Mycosel. El hongo aislado se identificó molecularmente mediante la amplificación, por reacción en cadena de la polimerasa (PCR) y secuenciación de la región espaciadora transcrita (ITS) de los genes ribosomales y de una porción del gen del factor de elongación 1 alfa (EF-1). La secuencia de nucleótidos de cada región fue comparada con las secuencias publicadas en la base de datos del Anco de Genes del Centro Nacional para la Información Biotecnológica (NCBI). Resultados: las características macro y microscópicas de la colonia concordaron con las directrices para Cylindrocarpon lichenicola (sinónimo Fusarium lichenicola). La secuencia de nucleótidos, tanto de la región ITS (544 pb) como de la porción del gen EF-1alfa (710 pb), presentó un 100 por ciento de similitud con secuencias de F. lichenicola. Conclusión: se identificó por primera vez en Costa Rica C. lichenicola asociado con onicomicosis en un paciente inmunosuprimidos. Este tipo de pacientes deben ser instruidos sobre las posibles fuentes de agentes infecciosos, particularmente los riesgos que pueden generar la jardinería y la agricultura...

Comparison of the performance of polymerase chain reaction and pp65 antigenemia for the detection of human cytomegalovirus in immunosuppressed patients / Comparação de métodos para detecção de infecção por citomegalovírus em pacientes imunossuprimidos

INTRODUCTION: Human cytomegalovirus (HCMV) is often reactive in latently infected immunosuppressed patients. Accordingly, HCMV remains one of the most common infections following solid organ and hemopoietic stem cell transplantations, resulting in significant morbidity, graft loss and occasional mortality. The early diagnosis of HCMV disease is important in immunosuppressed patients, since in these individuals, preemptive treatment is useful. The objective of this study was to compare the performance of the in-house qualitative polymerase chain reaction (PCR) and pp65 antigenemia to HCMV infection in immunosuppressed patients in the Hospital de Clínicas of Porto Alegre (HCPA). METHODS: A total of 216 blood samples collected between August 2006 and January 2007 were investigated. RESULTS: Among the samples analyzed, 81 (37.5 percent) were HCMV-positive by PCR, while 48 (22.2 percent) were positive for antigenemia. Considering antigenemia as the gold standard, sensitivity, specificity, positive predictive values and negative predictive values for PCR were 87.5 percent, 76.8 percent, 51.8 percent and 95.5 percent respectively. CONCLUSIONS: These results demonstrated that qualitative PCR has high sensitivity and negative predictive value (NPV). Consequently PCR is especially indicated for the initial diagnosis of HCMV infection. In the case of preemptive treatment strategy, identification of patients at high-risk for HCMV disease is fundamental and PCR can be useful tool.

INTRODUÇÃO: O citomegalovírus humano (HCMV), causador de infecção latente, reativa com frequência em pacientes imunossuprimidos. Portanto, o HCMV permanece uma das infecções mais comuns após transplantes de órgãos sólidos e de células hematopoiéticas resultando em significativa morbidade, perda do enxerto e ocasional mortalidade. Assim, o diagnóstico precoce para uma terapia preventiva é de grande importância. Este estudo visa comparar o desempenho dos métodos PCR qualitativo in-house e antigenemia pp65 para o diagnóstico de infecção por CMV em pacientes imunossuprimidos do Hospital de Clínicas de Porto Alegre. MÉTODOS: O estudo foi realizado em 216 amostras de sangue total (EDTA) coletadas de 85 pacientes, entre agosto de 2006 e janeiro de 2007. RESULTADOS: Dentre as 216 amostras analisadas, 81 (37,5 por cento) amostras apresentaram resultados positivos na PCR, enquanto 48 (22,2 por cento) apresentaram resultados positivos na antigenemia. A sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo para a PCR, considerando antigenemia como padrão foram 87,5 por cento, 76,8 por cento, 51,8 por cento e 95,5 por cento, respectivamente. CONCLUSÕES: Estes resultados demonstraram que a PCR tem alta sensibilidade e valor preditivo negativo. Consequentemente PCR é especialmente indicada para o diagnóstico inicial de infecção por HCMV. No caso da estratégia de terapia preventiva, a identificação de pacientes com alto risco para a doença por HCMV é fundamental e a PCR pode ser uma ferramenta útil.

Diagnosis and Clinical Presentation of Invasive Aspergillosis in Pediatric Hematology-Oncology Patients / 임상소아혈액종양

BACKGROUND: The useful tools for early diagnosis and diagnostic criteria need to be developed for controlling invasive aspergillosis (IA) which causes life-threatening conditions in high risk group such as immunocompromised hematology-oncology patients.METHODS: 103 cases of suspected IA on the ground of pathologic or Aspergillus Galactomannan (AG) test from March 2006 to March 2011 were reviewed. The patients with IA was classified into 4 groups 'Proven', 'Probable', ('Probable-1'), 'Possible' and 'Non' based on the criteria of European Organization for Research and Treatment of Cancer/Mycoses study Group (EORT/MSG) 2008 (and 2002).RESULTS: Of the 103 patients who underwent AG test, 16 cases were diagnosed as IA; 2 'Proven', 9 'Probable', 5 'Probable-1' and 4 'non' (false-positive). Underlying diseases were acute lymphoblastic leukemia (N=8), acute myeloid leukemia (N=5), severe aplastic anemia (N=4), neuroblastoma (N=2) and non-Hodgkin lymphoma (N=1). Risk factors were severe neutropenia for 10 days (80%), prolonged use of steroid (70%), receipt of an allogeneic stem cell transplant (45%) and treatment with immunosuppressants (40%). Major involved organs of IA were lung (N=15) and sinus (N=1). Overall sensitivity, specificity, positive predictive value and negative predictive value of the AG test were 94%, 95%, 79% and 99%, respectively. The mortality of 16 patients with IA was 50%.CONCLUSION: A combined use of the AG test and modified criteria of EORT/MSG 2008 allows not only early diagnosis but also prompt classifying risk groups of IA so that proper antifungal agents were used in pediatric hematology-oncology patients.